Program Adjustment Request Form Mini-Grant FY2020 1 Cover2 Program Adjustment Registered Coalition Name (as it appears on the registry):*Select Your Coalition2Degrees Prevention417SQUAD (Students Questioning Using and Abusing Drugs)Advocates for Better CommunitiesAffton CoalitionAll In Clayton CoalitionAlliance for Healthy CommunitiesAnne Marie ProjectAshland Helping YouthBelton CARESBenton County Healthcare CoalitionBenton County Youth CoalitionBollinger County Children and Youth IssuesBoone County Coalition to Prevent Substance UseBreathe Easy BoonvilleBreathe Easy KirksvilleBright Futures Knox Co.Brighter Futures Lafayette County Team CoalitionButler Bears Student AmbassadorsC.R.U.S.H. St. Charles CountyCaldwell County CaresCamden County Child Advocacy Council (CCCAC)Campbell C2000Carthage Caring Communities CoalitionCedar County Human Services CoalitionCharleston C2000Christian County Coalition on Substance MisuseClark County Health Department Wellness CoalitionCoalition TeamCommunities Taking ActionCommunity Organization for Drug Elimination (C.O.D.E.)Council for Drug Free YouthCounselors Who Care (C.W.C.) C2000CRUSH St. LouisDade County Connections/C-2000Dallas County Live Well AllianceDeSoto D.A.R.E., Inc.Dignity & AddictionDon't Meth With Missouri, Inc.Douglas County Community Health Assessment Resource Team (CHART) & Interagency CouncilDrug Responsibility Education & Advocacy Movement (DREAM)East Carter County Redbirds Against DrugsEl Dorado Drug Free Kids CoalitionExcelsior Springs S.A.F.E. (Supporting Abuse Free Environments)Families Support ProjectForRealFranklin County Youth CoalitionFredericktown Safe & Drug Free Schools & Community CoalitionFresh StartGenerate Health's Perinatal Behavioral Health InitiativeGreene County Alliance for Drug Endangered ChildrenGrundy County C2000Hallsville Youth CoalitionHands of Hope C2000Hardin School & Community TogetherHarrisonville Community Prevention CoalitionHazelwood Bright FuturesHealth Educators Smokebusters C2000Healthy Dent County Prevention CoalitionHealthy Futures Pulaski CountyHealthy Minds, Health Lives of Pike CountyHealthy Minds, Healthy Lives of Pike County Youth CoalitionHeartland Task ForceHenry County Honor CoalitionHickman Mills Prevention CoalitionHickory County Community Improvement CoalitionHOPE for Franklin CountyIvanhoe Neighborhood CouncilJefferson County Drug Endangered Children TaskforceJefferson County Drug Prevention CoalitionJohnson County Juvenile Justice CoalitionJoplin Area CoalitionKearney-Holt CANKnox County Awareness CoalitionLaclede County Drug CouncilLadue Coalition Against Underage DrinkingLafayette County Prevention CoalitionLake Area Promise AllianceLamar Drug-Free CoalitionLawrence County Prevention TeamLawson Community in ActionLebanon Positive ChoicesLee's Summit CARESLiberty Alliance for Youth, Inc.-LAFYILincoln County Drug and Alcohol Reduction TeamLinn County C2000Logan-Rogersville Safe and Drug Free Schools and CommunityMAAG - Mid-MO Addiction Awareness GroupMarion County Alliance for Substance Abuse Prevention (ASAP)Matthews C2000 SPIRIT TeamMcDonald County Community CoalitionMethamphetamine Action CoalitionMiller County Cares (MC2)Miss. Co. Youth Drug Prevention CoalitionMissouri City P.E.R.C.Missouri S & T Alcohol Prevention CoalitionMorgan County C.L.E.A.R. (Community Leaders Educating About Resistance)Neelyville TIGERS-Booster Club CoalitionNew Madrid County Community Resource CoalitionNewton County Community CoalitionNorth Platte Community In Action (CIA)Northland CoalitionNorthtown Teaching and Reaching Youth (TRY)Oak Park Community TRY (Teaching and Reaching Youth)Oak Park Neighborhood AssociationOrrick Community 2000 Task ForceOsage County Anti-Drug Community Action TeamOsceola Drug Free CoalitionOwensville Community Awareness and Resource Exchange (CARE)Ozarks Fighting BackPagedale Community AssociationPark Hill Community Alliance for YouthPemiscot Coalition for Alternative Youth InvolvementPerry County Community Task ForcePettis County Adolescent CoalitionPhelps County Child Advocacy Network (PCCAN)Platte County Prevention CoalitionProject: Healthy LivingPulaski County Coalition Against DrugsPutnam County Partners in PreventionRalls County HOPE (Healthy Outcomes, Preventative Education)Ray County CoalitionRayPec CaresReynolds County Maternal, Child, and Family Health CoalitionRichmond C-2000 Task ForceRisco C2000Rockwood Drug-Free CoalitionS.A.F.E - Sober and Fun EnvironmentS.A.Y.V. (Standing Against Youth Violence)Saint Louis University Midtown CoalitionSainte Genevieve Community Services ForumSmithville Community In Action (CIA)Southeast District Health Educator CoalitionSoutheast Kansas City Youth Prevention CoalitionSouthwest Missouri Initiative to Change Health (MO SWITCH)St. Francois County Community PartnershipSt. James Partners Acting to Reinforce Community (SPARC)St. Joseph Youth AllianceStaley Teaching & Reaching Youth - T.R.Y.Stand Against TraffickingStep Up of St. LouisStoddard County Health CoalitionStone County Community Health CoalitionSuicide Prevention Coalition of Southwest MissouriTaney County Alcohol and Drug Abuse Prevention Team (ADAPT)Teen Pregnancy & Responsibility NetworkThe Gathering TableThe One-Eighty Prevention CoalitionTobacco Free St. LouisTri-C (C2000 Conception)Underage Drinking Task ForceUnited Community ServicesUrban Prevention CoalitionVernon County Youth Enrichment CoalitionVernon County Youth Task Force CoalitionViolence Free FamiliesVoices of the YouthWARS (Warren County Alcohol/Drug Reduction Support)Washington County Community PartnershipWayne Inter-Agency Network (W.I.N.) CoalitionWe Can Be Drug Free Coalition - Butler CountyWebster County CommUNITY PartnershipWELL: Wentzville R-IV School District, Everyone Learning, for LifeWest Platte Community In Action (CIA)Youth Community Coalition (YC2)Youth With VisionGrant Number*Please select the correct MOU for your grant.MGA2020 - 1MGA2020 - 2MGA2020 - 3MGA2020 - 4MGA2020 - 5MGA2020 - 6MGA2020 - 7MGA2020- 8MGA2020- 9MGA2020 - 10MGA2020 - 11MGA2020 - 12MGA2020- 13MGA2020 - 14MGA2020 - 15MGA2020 - 16MGA2020 - 17MGA2020 - 18MGA2020 - 19MGA2020 - 20MGA2020 - 21MGA2020 - 22MGA2020 - 23MGA2020 - 24MGA2020 - 25MGA2020 - 26MGA2020 - 27MGA2020 - 28MGA2020 - 29MGA2020 - 30MGA2020 - 31MGA2020 - 32MGA2020 - 33MGA2020 - 34MGA2020 - 35MGA2020 - 36MGA2020 - 37MGA2020 - 38MGA2020 - 39MGA2020 - 40MGA2020 - 41MGA2020 - 42MGA2020 - 43MGA2020 - 44MGA2020 - 45MGA2020 - 46MGA2020 - 47MGA2020 - 48MGA2020 - 49MGA2020 - 50MGA2020 - 51MGA2020 - 52Please select the number that corresponds with the grant you were awarded. As listed on your Memorandum of Understanding (MOU).Grant Contact Person:* First Last Email* Prevention Resource Center:*PRC Prevention Specialist:* First Last Email* Title of Program/Activity Conducted:* Program AdjustmentDeadline for submitting adjustments is December 31, 2019. All program adjustment requests must be completed by the grantee and with the assistance of the Prevention Resource Center. Prevention Resource Centers will send the completed form to ACT Missouri.1. Describe the rationale for adjusting the grant’s budget.*2. List each budget line item and the dollar amounts that will change as a result of this adjustment.*Supplies and Materials: Total requested: $500.00. Adjustment Request: -$250.00 Media Campaign: Total requested: $400.00 Adjustment Request: +$250.00 3. Attach a revised action plan and timeline for implementing the changes, if indicated.* Drop files here or Deadline for submitting adjustments is December 31, 2019.If you have questions pleased contact aozenberger@actmissouri.org CommentsThis field is for validation purposes and should be left unchanged.