Get Community Coalition Application - Missouri Department Of Mental ... - Dmh Mo

The Community Coalition Application is a vital document for registering your coalition with the Division of Behavioral Health in Missouri. This guide provides clear instructions on each section of the form to help you complete it efficiently and accurately.

Follow the steps to fill out the Community Coalition Application effectively.

1. Press the ‘Get Form’ button to access the Community Coalition Application and open it for editing.
2. Select the type of application by checking either 'New' or 'Update' in the designated box.
3. Input the date of application. Next, fill in the coalition name and the coalition leader’s name.
4. Provide the street address, mailing address, city, phone number, email, county, zip code, fax number, and website if available.
5. State the coalition’s mission clearly, followed by listing the coalition’s goals and objectives.
6. Identify the coalition’s members by checking all applicable roles, including civic leaders, parents, school employees, and others.
7. Indicate how long the coalition has been active by selecting the appropriate duration.
8. Answer whether the coalition meets quarterly by selecting 'Yes' or 'No'.
9. Describe the geographic area served by the coalition by mentioning relevant counties, cities, or demographics.
10. State when the last community needs assessment was conducted by selecting one of the provided time frames.
11. Indicate whether the coalition's prevention activities are part of a comprehensive prevention plan.
12. Specify if the coalition supports or implements an evidence-based program or best practice, and name the program if applicable.
13. List the types of activities the coalition plans to support, checking all that apply.
14. Identify the coalition’s funding sources.
15. Confirm if your coalition is a CADCA registered coalition.
16. State whether the coalition performs evaluation outcomes measurement and describe the evaluation process if applicable.
17. Acknowledge that the information provided may be posted on the Department of Mental Health website.
18. Finally, submit the application to your Regional Support Center via the provided email or mail address. You can save changes, download, print, or share the completed form as needed.

Begin completing your application online to ensure timely registration of your coalition.