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Name of program for which you are applying for funding.
The objectives of the COMBAT Substance-Use Disorder Treatment funding application is to provide treatment services with an over reaching goal of achieving the following general outcomes for those who use drugs:
1) Counseling and/or medical-assisted programs leading to long-term recovery from drug use;
2) Retention in treatment for a period of time that maximizes treatment effects;
3) Improved employment and/or educational status;
4) Elimination of criminal behavior;
5) Improved family relationships and living environment; and
6) Creation or enhancement of a social support system that is conducive to recovery
IMPORTANT: The online application program will not permit you to continue to the next section of the website until you complete the section on which you are working.
A) Tax Clearance Required: Chapter 10, 1003 of the Jackson County Codes states “No person, firm or corporation, residing in Jackson County, or otherwise legally within the taxing jurisdiction of the County, shall be eligible to provide any goods, contractual services or anything covered by this chapter, unless that person, form or corporation is duly listed and assessed on the County tax rolls and is in no way delinquent on any taxes payable to the County” (Ord. 3839, Eff. 11/28/06). Tax Clearance is required for all applicants applying for funding.
B) Goal for Minority Hiring and Employment: Chapter 93, 9304 of the Jackson County Code regarding COMBAT states “Any proceeds from the Anti-Drug Sales Tax creating jobs and employment shall have a twenty percent goal for minority hiring and employment” (Ord. 1795, Sec. 4; Ord. 1941). Since this is a specific requirement for COMBAT, it is required during the application period and will be monitored.
Each funded organization must provide evidence of liability insurance coverage during the time of award of funding from Jackson County.
Applicant organizations must have on file a Compliance Certificate from Jackson County before any funding may be awarded.
Use this link to complete certification
A) Any organization requesting COMBAT funding must provide services to Jackson County residents in Jackson County.
B) Applicant organizations must provide a copy of a letter from the Internal Revenue Service indicating current 501.c.3 tax-exempt status.
C) Applicant organizations must provide proof of current Good Standing with the MO Secretary of State.
D) An applying agency must have been in existence for at least two years.
E) Applicant organizations must provide a copy of a certified financial audit (within the past two fiscal years).
F) Applicant organizations must provide a copy of a current IRS form 990 (within past two years) or extension letter.
G) COMBAT funding is provided on a reimbursement basis, available upon submission of receipts and proof of payment. It is strongly suggested that applicants have at least 10% of their program budget from other sources to provide these up-front funds.
H) COMBAT funds cannot be used for capital purchases.
I) COMBAT requires that all agencies receiving funding for Treatment services be certified by the State of Missouri, Division of Alcohol and Drug Abuse, or accredited or licensed by a nationally recognized accreditation/licensure organization, to provide substance-use disorder treatment services.
J) COMBAT requires that substance-use disorder treatment programs receiving COMBAT funding must accept referrals from Jackson County Drug Court.
K) All counseling services for substance-use disorder treatment must be delivered by individuals who are either Licensed or Certified Counselors as defined by the Missouri Division of Alcohol and Drug Abuse according to Certification Standards for Alcohol and Drug Abuse Program, 9 CSR 30-3.110 Section 6.
L) All COMBAT funded programs must participate in designated reporting systems to track information on COMBAT funded clients and services, including demographics.
M) Background screening must be performed on all persons providing direct services (paid treatment staff and/or volunteers) prior to their providing direct services in accordance with 9 CSR 10-5.190. Evidence of such checks, and the results obtained, must be kept in the organization’s personnel files and be available for review by COMBAT staff.
A) All counseling services must be delivered by individuals who are either Licensed or Certified Counselors as defined by the Missouri Division of Alcohol and Drug Abuse according to Certification Standards for Alcohol and Drug Abuse Program, 9 CSR 30-3.110 Section 6. Interns cannot be substituted for licensed or certified counselors and if used, must be supervised during sessions.
B) Any staff person providing family counseling must be qualified to provide family counseling according to Certification Standards for Alcohol and Drug Abuse Program, 9 CSR 30-3.110 Section 6.
C) Any staff person providing counseling services to adolescents must be qualified according to pages 56-58, Certification Standards for Alcohol and Drug Abuse Program, 9 CSR 30-3.192.
D) Any staff members providing therapeutic day care, children’s activities, or children’s learning groups must be qualified according to Certification Standards for Alcohol and Drug Abuse Program 9 CSR 30-3.190.
I have read all requirements for 2021 COMBAT Substance-Use Disorder Treatment funding.
Treatment program that would receive COMBAT funding
Amount of COMBAT funding being applied for
Write "NONE" if no site exists
Person preparing and submitting this application
Individual who will directing program that would receive COMBAT funding
Address(es) where program services will be provided. List only those locations where the COMBAT-funded program's services will be available, not all locations where your organization provides services.
If you selected other under "Location Type," specify that location type here.
Include name of commuinity center, school, church, etc. if applicable.
Include name of community center, school, chruch, etc. if applicable
Include name of community center, school, church, etc. if appliciable.
If more than 12 program addresses, please list remainder here with name, street address, city, state, zip and phone number.
If you selected "Level 7 - Recovery House" above, you must select at least 1 of 3 levels here:
Please discuss program or level of service(s) Purpose Statement: The purpose of a program or level of service(s) is to achieve outcomes. It is driven by audience needs and considerations (for whom) It provides a solution to meet those needs (what we do) It fulfills the organization's mission. It defines audience, activities, services, and outcomes.Please discuss program or level of service(s) goal(s): Goals are typically broad general statements that describe what the program or level of service(s) plan to accomplish. Goals, establish the overall direction for and focus of a program or level of service(s). Goals define the scope of what the program or level of service(s) should achieve and serves as the foundation for developing program or level of service(s) objectives.Please discuss the Need: What problem or opportunity does the program or level of service(s) addresses? Who experiences it?List prevalent risk-factors that will be addressed in your 2020 proposal.List which protective-factors will be utilized in buffering prevalent risk-factors.Expected Effects: What changes resulting from the program or level of service(s) are anticipated?
What must the program or level of service(s) accomplish to be considered successful?Intervention Activities: What steps, strategies, or actions will the program or level of service(s) take to effect change?
Briefly describe your program, addressing the areas you selected on the Cover page. If funded, this will be the program description used by COMBAT on our website and other publications about our funded programs. Be sure to address your target population, services/activities to be provided and expected outcome of your program.
What is the Problem leading to the program you are proposing? Describe the needs that you see as associated with this problem, using local and current information:
What are the issues your program will be addressing in the community?
Pleasse list 3 specific outcomes you expect for clients in your program/project.
Describe age, ethnic breakdown, gender and geographical area of clients to be served.
% In This Age Group
% Of Male Clients
% Of Female Clients
Percentage of clients expected to serve from each of these ethnic/racial groups.
(Not Hispanic or Latino)
(Or Other Pacific Islander)
How will you get clients into this program?
Currently what are your major referral sources? Please list number of clients referred from each source.
What type of follow-up services will you provide?
List the drugs reported by clients in this program so far this year, and the number of clients who have reported using each drug to date.
Include Client Numbers
% Of Male Staff
% Of Female Staff
Percentage of Staff Members from each of these ethnic/racial groups.
What outcomes have your clients achieved in each of these areas through July 2020? State in terms of % improvement from total % of clients at Intake vs. Total% for clients at time of discharge
As Measured By Drug Testing
1) COMBAT funds may not be used to provide capital improvements (Article 6, Section 23 of the Mo. Constitution).
2) Funds may not be used to pay salaries for functions that have traditionally been performed by volunteers.
3) COMBAT funds may not be used to pay rent, utilities, equipment or for out of town travel.
Other Funding Amount
Number of Other Sources
Maximum 10% of Salaries (Describe Benefits Below)
Other Funding Amoung
Other Funding Amounts
Level 1, 2 and 3 services are paid on an all-inclusive per diem rate.
Number Expected To Serve
Number of Units
Units x Unit Price
Unit x Unit Price
Number Expected to Serve
These documents MUST be attached in the spaces below before submitting. PDF, Word and Excel documents are accepted.
Jackson County Compliance Report Form completed and signed or existing certificate (if you have one). Download This Form (PDF)
Copy of Paid Jackson County Property tax receipt or current exemption certificate.
Copy of evidence of liability insurance coverage for at least $1 million.
Copy of current IRS Form 990 (within past two fiscal years 2018 or 2019).
Copy of full Certified Financial Audit (within past two fiscal years 2018 or 2019).
Copy of letter indicating current IRS 501(c)(3) tax-exempt status (if applicant is not a governmental agency, e.g., city, school district or court in Jackson County).
Certificate of Good Standing from the Missouri Secretary of State.
List of Staff with titles and copies of certifications
List of Board of Directors
Program Summary: XI) Key Partners
You must include a current letter stating that these partners are aware that they will be part of a COMBAT project.
By clicking "Agree," you agree and acknowledge that information and statements provided in this application are, to the best of your knowledge, true and accurate.
By typing your name in the "Signature" box below, you acknowledge that this "electronic signature" is valid and binding upon you to the same force and effect of a traditional handwritten signature.
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