Foster Youth Substance Use Disorder

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Be sure to read the Foster Youth Substance Use Disorder guidelines and instructions in the Request for Applications (RFA) carefully before beginning your application. Required fields and attachment uploads are marked with a red * (asterisk).

You may save your in-progress application at any time and return to it later using the link you will receive in an automated e-mail.

If you have questions, send an email to fysud@sierrahealth.org with the subject line: Foster Youth Substance Use Disorder.

Use Tab key or mouse click to move from field to field. Clicking Enter will attempt to Submit an incomplete application.

After submission you will receive an email confirmation along with a printable PDF copy of your application.

Note: Application deadline is February 23, 2024 at 1:00pm.

Is the project sponsored by the applicant organization?
A fiscal sponsor is an organization that applies on behalf of an entity or group that does not have legal standing with the IRS.

YesNo

ORGANIZATION AND CONTACT INFORMATION

This section is to be completed by the IRS qualifying organization; please use the legal name as registered with the IRS.

Organization Contact Information

Organization Name

Street Address

City

State/Province

Provide the two letter state or territory abbreviation.

Zip/Postal Code

County (choose other if not in CA)

Other County

Phone

Website/URL (optional)

Organization Financial Information

Answer the following questions about the applicant organization's financial information. If there is a fiscal sponsor for this project, answer the questions for the fiscal sponsor.

What is your annual budget amount?

Organization Tax ID #

Organization Status – Does the organization have 501(c)(3) nonprofit status with the IRS.

Yes. Organization has 501 (c) (3) nonprofit status with the IRS.No. Organization does not have 501 (c) (3) nonprofit status with the IRS.Unsure. Organization is unsure if it has 501 (c) (3) nonprofit status with the IRS.

Legal entity: Please select the closest option for legal entity from the options below. This should match what the organization wrote in question 3 on the W-9:

If you chose Other for Legal Entity please describe (255 character maximum)

CEO/Director of the Organization

The CEO/Director should be associated with the qualifying organization above.

First Name

Last Name

Title

Office Phone

Phone Extension

SPONSORED ENTITY INFORMATION

If applying for funds through a fiscal sponsorship you are the sponsored entity. The fiscal sponsor should be the applicant organization above. Provide information about the sponsored entity or project in the fields below.

Sponsored Entity Name

Street Address

City

State/Province

Provide the two letter state or territory abbreviation.

Zip/Postal Code

County (choose other if not in CA)

Other County

Phone

Website/URL (optional)

What is your annual budget amount?

Proposal Contact Information

Would you like the CEO/Director entered above to be the Proposal Contact (the contact who can answer questions about this proposal)?

YesNo

Enter information for a contact who can answer questions about this proposal.

First Name

Last Name

Title

Office Phone

Phone Extension

The Proposal Contact is affiliated with the following organization:

Program Contact Information

Choose one of the previously entered contacts to be the Primary Program Contact. Or enter an additional contact. This person will be contacted if there are questions or updates regarding the Program.

Because the project has fiscal sponsor please enter a contact affiliated with the fiscally sponsored organization to be the Primary Program Contact. This person will be contacted if there are questions or updates regarding the program.

First Name

Last Name

Title

Office Phone

Phone Extension

Optional Contacts

Additional Program Contact: Choose one of the previously entered contacts to be an Additional Program Contact, select "Enter an Additional Program Contact" to provide information about another contact, or select "No Additional Program Contact is Needed".

Additional Program Contact

First Name

Last Name

Title

Office Phone

Phone Extension

Additional Program Contact is affiliated with the following organization:

Data Contact of the Organization: Choose one of the previously entered contacts to be the the Data Contact, select "Enter a Data Contact of the Organization" to provide information about another contact, or select "No Data Contact is Needed".

Data Contact of the Organization

First Name

Last Name

Title

Office Phone

Phone Extension

The Data Contact is affiliated with the following organization:

Financial Contact of the Organization: Choose one of the previously entered contacts to be the the Financial Contact, select "Enter a Financial Contact of the Organization" to provide information about another contact, or select "No Financial Contact is Needed".

Financial Contact of the Organization

First Name

Last Name

Title

Office Phone

Phone Extension

The Financial Contact is affiliated with the following organization:

PROJECT OVERVIEW

Project Description

Name of Project (10 words maximum)

Brief Summary and Purpose of Project (75 words maximum)

Project Start Date

Project End Date

Amount Requested

Up to $250,000 for each application

Project Geography (County Level)

Please indicate what percentage of activity will be spent in which California counties. Total must add up to 100.

Alameda

Alpine

Amador

Butte

Calaveras

Colusa

Contra Costa

Del Norte

El Dorado

Fresno

Glenn

Humboldt

Imperial

Inyo

Kern

Kings

Lake

Lassen

Los Angeles

Madera

Marin

Mariposa

Mendocino

Merced

Modoc

Mono

Monterey

Napa

Nevada

Orange

Placer

Plumas

Riverside

Sacramento

San Benito

San Bernadino

San Diego

San Francisco

San Joaquin

San Luis Obispo

San Mateo

Santa Barbara

Santa Clara

Santa Cruz

Shasta

Sierra

Siskiyou

Solano

Sonoma

Stanislaus

Sutter

Tehama

Trinity

Tulare

Tuolumne

Ventura

Yolo

Yuba

Total Geography Percentage:

Total must equal 100%. Please adjust accordingly.

Project Race and Ethnic Group

Estimate in percentages the race and ethnic groups that will be affected (Total must add up to 100).

American Indian and Alaska Native (e.g., Navajo Nation, Blackfeet Tribe, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.):

Asian-American (e.g., East Asian, South Asian, Southeast Asian, or Asian American, etc.):

Black or African American (e.g., African American, Nigerian, Ethiopian, Somali, Afro Caribbean or Afro Latinx, etc.):

Hispanic or Latino (e.g., Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Columbian, another country of Latin America or Spanish origin, etc.):

Indigenous (e.g., Mixteco, Purepecha, etc):

Middle Eastern or North African (e.g., Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc.):

Pacific Islander (e.g., Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.):

White (e.g., German, Irish, English, Italian, Polish, French, etc.):

Multi-racial/Multi-ethnic:

Another race ethnicity, or origin not on the list:

Other (please specify)

Total Percentage of Race and Ethnicity

Total must equal 100%. Please adjust accordingly.

Project Age Group

Estimate in percentages the age groups that will be affected (Total must add up to 100).

Under 5

5 - 11

12 - 15

16 - 18

19 - 21

22 - 26

26+

Total Percentage of Age

Total of Age Groups must equal 100%. Please adjust accordingly.

Evidence-Based Models and Promising Practices

This funding opportunity must implement one of the following evidence-based models or promising practices. Please indicate which model or practice your organization will implement for this project.

If selecting EBPPs not already identified on the list, please provide sufficient explanation on why the EBPP(s) were chosen and how they meet the objectives and required approaches of this grant program (trauma-informed care, harm-reduction approaches, post treatment support planning, and training for clinical service providers).

How do you propose to apply the EBPP(s) through trauma-informed care?

How do you propose to incorporate harm reduction approaches in implementing the EBPP(s)?

NARRATIVE QUESTIONS

1. Organization Description. Provide a brief overview of your organization, a) when it was established, b) your organization’s mission, c) whom you serve, d) geographic area your organization covers, and e) the types of programs you operate. (175 word maximum)

2. Fiscal Sponsor Description. If the project has a fiscal sponsor that is different from the organization that is implementing the project, briefly describe the fiscal sponsor, including its mission and any past and/or current work with the sponsored organization. (175 word maximum)

3. Organizational Capacity. Describe the qualifications of the project leaders and key staff on the project. Specify which positions have staff in place and which will need to be filled. Explain how these qualifications demonstrate an ability to be culturally responsive in carrying out the activities identified above. (250 word maximum)

4. Track Record with Proposed Focus Population. Share your organization's experience in utilizing a trauma-informed care approach to delivering youth focused behavioral health services. Describe your organization’s experience in providing services that incorporate The required implementation activities, such as harm reduction and positive youth development. Briefly describe 1-3 examples of your work with this community (or communities). (250 word maximum)

5. Use of Funds. Describe in detail your plan to use these funds to implement evidence-based models and promising practices to serve foster youth with substance use disorders who reside in family-based settings. Describe the evidence-based model or promising practice you will employ and list the specific activities, additional strategies, outreach, and resources need to carry out your proposed project. Provide a timeline for the planning process, staff onboarding and practitioner training, and implementation stages. (750 word maximum)

6. Partnerships. Describe partnerships that are already in place or will be established to support implementation of your proposed project. If no partners are needed, please explain. (200 word maximum)

7. Objectives. List 3-7 project objectives. (250 maximum)

8. Monitoring and Evaluation. Describe your project team’s capacity to document, monitor, or evaluate project activities, outputs, and outcomes. (300 word maximum)

9. Technical Assistance. To help us plan a technical assistance strategy, please tell us what technical assistance your organization would benefit from in implementing this project? (Your response to this question is not considered in decisions about funding).  (150 words maximum)

Required Attachments

Please note: Grant applications may not be considered if requested attachments are not included or completed. Please upload your file only once for each requirement.

Proposed Budget Project Budget. Download The Center’s budget template here. Tab 1 “Budget Worksheet” should detail your proposed budget for this project. Tab 2 “Budget Justification” should detail why you are requesting these dollars and what it will cover for the project term. Both Tab 1 and Tab 2 must be filled in for the Budget and Budget Justification to be considered complete. Upload your budget and budget justification in excel format only.

Applicant organizations W-9. Upload the applicant organization’s W-9 in PDF format.

DHCS License and/or Certification. Applicable only for organizations that are providing treatment services.

Use Tab key or mouse click to move from field to field. Clicking Enter will attempt to Submit an incomplete application.

An email confirming the submission of your application will be sent to the project’s primary contact. If you do not receive an email, please contact fysud@sierrahealth.org.

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