Welcome to the California Department of Alcohol and Drug Programs

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