Request Assistance

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Date

Our Agency name is

Our Agency is requesting financial assistance to utilize CLEAR Alliance’s educational courses. We are committed to providing these educational courses equitably for the public we serve if we could remove the financial barrier.

EDUCATIONAL COURSE(S) NEEDED (select one or more)

TMEC (Tobacco Marijuana & E-Cigarette Course)

CPEC Coming soon! (Counterfeit Pill Education Course)

PRE-TMEC Coming soon! (Tobacco Marijuana E-Cigarette for elementary students)

IDEC (Impaired Driving Education Course)

VAPEC Coming soon! (Vaping Education Course)

TAKE COURSE: How many e-learning courses does your agency anticipate needing?

TEACH COURSE: How many instructor licenses does your agency anticipate needing?

OUR TRAINING REQUEST

Zoom training

In-person training

OUR COMMITMENT (select one or more)
I / my agency will:

Contribute up to this amount in matching funds:Contribute up to this amount in matching funds:

Provide a training location and/or cover training/travel costs

Be a pilot site to contribute student/staff input/feedback

Offer interns or volunteer assistance

Offer media support or other services

Cover substitute fees for our staff to attend the training

Participate in a CLEAR Alliance coalition or as an Advisory Member

OtherOther

Once funds are secured, our agency will implement the educational courses for the youth and adults we serve. I understand this letter may need to be updated annually or if our need changes.
Respectfully,

Print Name & Title

Phone

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State

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541.508.3062

info@clearalliance.org

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