Sample Resolution Form: Substance Abuse and Crime Prevention

Sample Resolution Form

SAMPLE - Board of Supervisors Resolution

ENCLOSURE C

DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS 1700 K STREET SACRAMENTO, CALIFORNIA 95814	TELEPHONE (916) 322-7012 FACSIMILE (916) 323-0653
- SAMPLE - SUBSTANCE ABUSE AND CRIME PREVENTION ACT OF 2000 LEAD AGENCY INFORMATION FORM FISCAL YEAR 2000-2001 FUNDING

Date:

SECTION 1 – COUNTY INFORMATION

County:

Designated Lead Agency:

Department:

Address:

Telephone #:

E-Mail Address/Facsimile:

SECTION 2 – COUNTY SUBSTANCE ABUSE AND CRIME PREVENTION ACT AGENCY LIST

(List all agencies participating in collaboration and planning efforts.)

NAME

TITLE

AGENCY/
ORGANIZATION