OPAL Material Request Form
The York Opioid Collaborative invites you to work with us in our OPAL- Overdose Prevention Assistance Locally program.  As a partner agency, you will have access to FREE print materials and downloadable materials.  These items may ONLY be used as they are designed, with no unapproved alterations.   There may be finished materials designed to include designated space to add custom contact information, however beyond this addition, materials may NOT be altered without the express knowledge and written permission of the York Opioid Collaborative.  

Partnering agencies will be eligible to receive a maximum of 50 of each print material at a time.  Additional print materials will be distributed based on utilization and need.  

OPAL is a community-level Narcan distribution program aimed at increasing consistent messaging around Narcan, discount myths, increase education about overdose prevention strategies and increase access to Narcan.  

Partnering agencies are asked to keep track of materials disseminated and report usage of materials to York Opioid Collaborative.  A separate reporting tool is created to help collect this information.

Please complete the following information before utilizing OPAL materials to indicate agreement of usage terms.
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Partner Agency *
Contact Name *
Phone Number
Email *
Date of Agreement *
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OPAL Materials *
Required
OPAL Signs/symptoms and how to respond accordion Cards English- Quantity Requested (maximum of 50)
OPAL Signs/symptoms and how to respond accordion Cards Spanish (maximum of 50)
Myths/Facts Sheet (maximum of 50)
OPAL Program Brochure English (maximum of 50)
OPAL Program Flyer English (maximum of 50)
Narcan utilization reporting cards (maximum of 50)
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