Proposals for Opioid Abatement Funding

Organizations that are interested in applying for abatement funds may use the following form. The form provides the town and the decision-making committee with a clear snapshot of how your organization intends to mitigate the ongoing opioid crisis in Weymouth.

Please reach out to The Health Department at 781-340-5008 with any questions.

Date Submitted

Month

Day

Year

Project Name:

Submitted by:

Address of Submitting Party:

Summary:

Statement of Need - Please indicate if your organization currently receives any state, federal, or private funding:

Program Description:

Goals & Objectives:

Budget Timeline:

One-Time Request

Reoccurring Payments

Timeline (Cont.) - Please enter Activities followed by Projected Dates:

Budget Overview:

Please enter an itemized list of budget needs: 1. Item Description 2. Price 3. Quantity 4. Total

Total Budget Need:

Leave this field blank

Departments

Boards & Committees

Proposals for Opioid Abatement Funding