Opioid Funds Application

The Town of Medway received funds from the Massachusetts Opioid Abatement Settlement, which will be used to implement strategies to combat the opioid epidemic in Medway. If you are an organization or individual interested in obtaining funds to support opioid abatement initiatives, please fill out the application below as a review team will begin to review all applications at the beginning of October.

Name of Applicant *

Email *

Phone Number *

Name of Organization

EIN#

Mailing Address *

Physical Address *

Name of Main Contact Person *

Program Director

Program Director's Email

Program Director's Phone Number

List of all Board of Directors' Members

Relationship to opioid funding *

(Prevention, Harm Reduction, Treatment, Recovery)

Please describe your desired program *

Please provide a proposed budget for this program *

Include a detailed breakdown of all costs.

Timeline for completion *

If there are multiple goals to complete, then describe timelines for each goal.

Please describe measurable outcomes for the program you plan to implement *

Please list any existing fiscal partners *

If there are fiscal partners, then a letter of agreement must be attached to the application from fiscal partners (below)

Fiscal Partner Letter

Files must be less than 5 MB.
Allowed file types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Leave this field blank

Boards

Committees

Opioid Funds Application