Questions marked with a * are required
Co-occurring Disorders Program (CDP)

Grant Writing Toolkit Request Form
 
Are you in the process of writing for grant funds now? *
 
Yes
 
No
 
If yes, to which funding source are you applying?
   
 
Please describe your organization’s primary goal in implementing the Co-occurring Disorders Program (CDP)?
   
 
 
Contact Information
First Name * :
Last Name * :
Address 1 * :
Address 2    :
City * :
    State * :       Zip * :  
Phone * :
Email Address * :
 
 
How would you classify the setting in which you will implement CDP? (please check all that apply) *
 
Residential Treatment
 
Outpatient Treatment
 
Day Treatment
 
Mental Health
 
Hospital-based
 
Family
 
Corrections
 
Independent Counseling Practice
 
What is the licensure or certification of the organization with which you will implement CDP? (please check all that apply) *
 
Addiction only services (AOD)
 
Mental Health only services (MHOD)
 
Dual Diagnosis
 
Other
    
 
Please list the approximate number of clients that your organization serves annually. *
   
 
To help us better serve your grant writing needs in the future, please check each of the following that you would consider implementing in your program if you had the necessary funding. Like CDP, these programs were developed by the faculty from the Dartmouth Psychiatric Research Center (PRC), and can be found at hazelden.org/bookstore. *
 
Integrated Dual Diagnosis Treatment: Best Practices, Skills, and Resources for Successful Client Care (IDDT)
 
The IDDT Recovery Life Skills Program: A Group Approach to Relapse Prevention and Healthy Living (available in 2011)
 
Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction
 
Supported Employment: Applying the Individual Placement and Support (IPS) Model to Help Clients Compete in the Workforce (available in 2011)
 
Illness Management in Recovery: Personalized Skills and Strategies for Those with Mental Illness
 
Cognitive Behavioral Therapy for PTSD: A Program for Addiction Professionals