Wyoming County Opioid Settlement Funds Application

Complete the form below to apply for opioid settlement funding. Applications will be reviewed by the Wyoming County Opioid Settlement Committee. For questions, contact us at WyomingCountyOSC@wyomingcountypa.gov. LEARN MORE: https://wyomingcountypa.gov/onepillcankill/

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Primary Contact Person *

Email *

Phone Number *

Fax Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Federal Identification Number (EIN)

Project Name *

Total Amount Requested *

Expected Program Start Date *

Project Narrative *

Reducing Opioid Use *

Project Evaluation

Budget Proposal *

Upload Supporting Documents

Click or drag a file to this area to upload.