Program Template


Please note: this will be posted on the wiki so please do not include information you do not want available on the web

Name of Organization

  • Organization address
  • Organization website
  • General contact email for organization
  • Contact telephone for organization
  • FAX:
  • TTY:
Description of the organization.

Name/Title of 1st Prevention Program

  • Program contact person's name, job title
  • Program contact person's information (email, telephone, etc)
  • Program website
Description of the prevention program.

Materials/Curriculum/Campaign Used/Adapted


Resources Available

  • Product A here: include description and how to obtain
  • Product B here: include description and how to obtain

Evaluation Efforts


Funding Sources


Samples of Materials/Exercises/ etc

  • Sample A
  • Sample B


Name/Title of 2nd Prevention Program

  • Program contact person's name, job title
  • Program contact person's information (email, telephone, etc)
  • Program website
Description of the prevention program.

Materials/Curriculum/Campaign Used/Adapted


Resources Available

  • Product A here: include description and how to obtain
  • Product B here: include description and how to obtain

Evaluation Efforts


Funding Sources


Samples of Materials/Exercises/ etc

  • Sample A
  • Sample B