Mini Grant Application Montana Tobacco Use Prevention Program reACT Against Corporate Tobacco Sponsor Group/Organization Group Name * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone * Email * Website (if applicable) Primary Youth Contact Info Name * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone * Email * Organization * Primary Adult/Advisor Contact Info Group Name * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone * Email * Website (if applicable) Select Your Topic Topics * Tobacco Products Prevention Campaign Days of Action Tobacco-Free Events Tobacco Products Prevention Campaign Choices Cessation Promotion Difference between Commercial & Traditional Tobacco in the American Indian Community Point of Sale Inclusion of E-cigarettes in the Clean Indoor Air Act (CIAA) Project Narrative Montana Tobacco Use Prevention Program Mini-Grant applications should be developed in collaboration by teens and adults. DO NOT leave any questions unanswered. Your Program Now and Then Tell us about your program currently and your goals this academic year. How can a reACT Mini Grant help? * What steps will you take to find and work with youth? * Proposed Budget Please include a detailed budget list (bullet-points) of how this mini-grant can help you to reach your goals. Please round to the nearest dollar amount.* Game Plan Please answer the questions below in 350 words or less: * Audience: What specific community, or group of youth, do you hope to reach with your project? How many youth or community members do you plan to recruit to your organization? Goals: What is the goal of your activities? What do you hope your community will get out of the project? How is it related to your topic choice? Process: How are you going to accomplish these goals? What activities and projects are you planning? Results Please answer the questions below in approximately 400 words: * How will this project specifically support reACT goals? For help with this question please read the reACT goals located on the Mini Grant Guidance Document. What evaluation tool will you use to evaluate the impact of your program (see evaluation toolkit)? W-9 Submission Upload W-9 here * Drop a file here or click to upload Choose File Maximum upload size: 516MB Additional Questions: Call Ashley Burke at 406-444-1288 or email at [email protected] . We are willing to answer questions and provide support however possible and look forward to hearing from you. reCAPTCHA If you are human, leave this field blank. Submit