Substance use prevention program
Scholarship Application

The Alice Aycock Poe Center for Health Education has a limited number of scholarship opportunities for organizations within Wake County that are interested in providing an established substance use prevention program. Please complete the following information in it's entirety.

For youth program options: https://www.poehealth.org/educational-topics/drug-prevention/

For adult program options: https://www.poehealth.org/educational-topics/adults/

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* 1. Main Contact Name:

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* 2. Organization/Agency Name:

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* 3. Email:

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* 4. Mailing Address (include street, city/town, state and zip code):

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* 5. Contact Phone Numbers:

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* 6. Host site name and location if different from above (include street, city/town, state and zip code):

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* 7. Website:

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* 8. I am interested in applying for a scholarship to offer the following Poe Center Program:

#Youth Culture - Adolescent Brain and Social Media (90 minutes)

#Youth Culture - Adolescent Brain Development and Addiction (90 minutes)

#Youth Culture - Adolescent Brain and Social Media (90 minutes)

#Youth Culture - Dating Relationships and Sexting (90 minutes)

#Youth Culture - General Program (2 hours)

#Youth Culture - Navigating "The Talk" (90 minutes)

Bullying Uncovered (75 minutes)

Choices & Consequences (60 minutes)

Drugs Uncovered (2 hours)

For The Health Of It! (60 minutes)

It's Up 2 U! (45 minutes)

Opioids 101 (90 minutes)

Science of Addiction (90 minutes)

Understanding Opioids (90 minutes)

What's All The Buzz?! (60 minutes)

#Youth Culture - Adolescent Brain Development and Addiction (1.5 hours)

Substance use prevention program
Scholarship Application

Question Title

* 1. Main Contact Name:

Question Title

* 2. Organization/Agency Name:

Question Title

* 3. Email:

Question Title

* 4. Mailing Address (include street, city/town, state and zip code):

Question Title

* 5. Contact Phone Numbers:

Question Title

* 6. Host site name and location if different from above (include street, city/town, state and zip code):

Question Title

* 7. Website:

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* 8. I am interested in applying for a scholarship to offer the following Poe Center Program:

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* 9. If you are requesting a scholarship for an adult program, is your organization prepared to offer child care if needed?

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* 10. If you were granted a scholarship to provide this program, how would you advertise to your community or invite people?

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* 11. What amount of money, if any, could you contribute toward payment of this program?

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* 12. Estimate of number of people that would attend this Poe Center program:

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* 13. Please share why your organization is in need of a scholarship for a Poe Center Program.