Substance Misuse Prevention School Curriculum Request Form

Free prevention curriculum for Vermont schools in region 3
Funding provided by: Northeast Vermont Prevention Consortium - Prevention Lead Region 3 and Vermont Division of Substance Use Programs.

Please complete the form below to request curriculum materials for your school at no cost. Please do not select any items that already have an identified funding source in your school.

Completion of this form does not guarantee funding.  

Form due on or before June 1, 2025 - first come first served on a rolling basis. Please apply ASAP!

Region 3 consists of: LNSU, LSSU, OSSU, NCSU, OCSU, ENSU, SJSD, KESU, BMU, & CCSU

This process is in response to the recent Region 3 School Needs Assessment conducted by Pacific Institute of Research and Evaluation.

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E-Mail-Adresse *
School Name *
Mailing Address *
Primary Contact (name, email, & phone number) *
Type of Curriculum Requested (Please do the breakout questions below for each that you check) *
Pflichtfrage
Option 6 - Other: If you are requesting a curriculum not listed above, please include the name of the curriculum and briefly describe how it aligns with your school’s prevention goals. Let us know if it is evidence-based, whether it’s already being implemented, and any additional context that would help us understand your request.  Please include the total cost.
If you are requesting more than one option, please prioritize request.  
Grade-Level Details
Please list the grade(s) (K-12), number of students, and teacher manuals needed per grade (if applicable):
 *
Do you currently have staff available to implement the curriculum? *
Implementation Plan
How do you plan to implement the curriculum? (Check all that apply)
 *
Pflichtfrage
How will this build prevention capacity in your school? (for example: strengthening staff skills, adding prevention programming, reaching new student groups, etc.)   *
Willingness to Share Updates/Simple Evalutation
Would you be willing to provide updates on curriculum use in December of 2025 and June of 2026? 

Updates would include:

Number of staff trained and/or implementing the curriculum

Number of students trained to facilitate (if applicable)

Grade levels and number of students servedHow the curriculum has helped build prevention capacity

Successes and lessons learnedIf not yet implemented: barriers you faced and your plan for implementation

(Optional) Photos we can share to highlight your school's prevention efforts

 *
Thank you for your request!  We will review and get back to you soon!
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