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H.Ed.G.E. Your Bets™ Online Application
 

Campus Name: FIELD

City: [FIELD]

Primary Contact Information for School

Name: [FIELD]

Title: [FIELD]

Address: [FIELD]

City: [FIELD] State:[FIELD] ZIP: [FIELD]

Phone: [FIELD]

Fax: [FIELD]

Email: [FIELD]

Fiscal Contact information

Name: [FIELD]

Title: [FIELD]

Address: [FIELD]

City: [FIELD] State:[FIELD] ZIP: [FIELD]

Phone: [FIELD]

Fax: [FIELD]

Email: [FIELD]


We are applying for:

q     Awareness & Prevention $600 Mini-Grant (Fill Out Part I Only)

q     Research $600 Mini-Grant (Fill Out Part II Only)

q     Comprehensive Awareness, Prevention & Research Program $1,500 Grant (Fill out Part I and Part II)

 

PART I: AWARENESS & PREVENTION

AWARENESS & PREVENTION ACTIVITIES ($600 mini-grant)
Select  4 of the activities below. At least one must be from Group A, and at least one must be conducted during National Problem Gambling Awareness Week (March). The other three can be from either group and may be conducted anytime in 2010.

 

Group A

q     Broadcast E-Mail to Students and Campus Radio/Closed Circuit TV
q     Luncheon Speaking Event (March)
q     New & Transfer-Student Orientation Packets AND Family Packets (Spring & Fall)
q     Movie-Night (March) [check one from this group]
     q     "21"
     q     "Rounders"
     q     "Waking Ned Devine"
     q     "Owning Mahony"
     q     Your Movie Suggestion*: [FIELD]

 

Group B
q     Intramural/Impromptu Sports Competitions (Anytime)
q     Chalking-Up the Sidewalks (Anytime; best just before another event)
q     Stress Busters Event (March)
q     Alcohol Awareness Day Event (April)
q     Smoking Cessation Day Event (May)
q     Depression Screening Day Event (October)
q     Campaign to Examine & Dispel Myths
q     Your Activity Idea*: [FIELD]

 

EVALUATION
Must select minimum of 1.

q     Pre & Post Event Questionnaires
q     Your Alternative Evaluation Method Here*: [FIELD]

 

PROMOTIONAL ITEMS
Select no more than 150 items.

q     25 Book Marks
q     50 Rulers
q     50 Chip-Clips
q     50 Frisbees
q     50 Magnetic Clips
q     50 Water Bottles
q     100 Sports Themed Stress Balls (subject to season and availability)
q     100 Pens
q     100 Pencils
q     100 of Your Give-Away Idea*: [FIELD]


PART II: RESEARCH
The following options require final approval by CCPG prior to dissemination

 

RESEARCH ACTIVITIES ($600 mini-grant)
Must select 1 or more.

q     Student Attitudes, Beliefs, and Behaviors Survey
q     Parental Attitudes, Beliefs, and Behaviors Survey
q     Tracking of Disorders which Co-Occur with Problem Gambling
q     Select your own Research idea [FIELD]

 

ADDITIONAL PROMOTIONAL ITEMS
Select no more than 150 items

q     25 Book Marks
q     50 Rulers
q     50 Chip-Clips
q     50 Frisbees
q     50 Magnetic Clips
q     50 Water Bottles
q     100 Sports Themed Stress Balls (subject to season and availability)
q     100 Pens
q     100 Pencils
q     100 of Your Give-Away Idea*: [FIELD]

 
* Any movie, activity, evaluation method or promotional item suggested by you is subject to CCPG approval.

©2009, H.Ed.G.E. Your Bets™, Connecticut Council on Problem Gambling. No part of this document may be reproduced without written consent from the Connecticut Council on Problem Gambling.
 
 
       

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