Blue Hills Community Health Alliance (CHNA20) Encompassing the towns of Braintree, Canton, Cohasset, Hingham, Hull, Milton, Norwell, Norwood, Quincy, Randolph, Scituate, Sharon, and Weymouth
REQUEST FOR APPLICATION (RFA) 2015 COMMUNiITY GRANT
INTRODUCTION The Blue Hills Community Health Alliance (CHNA 20) is pleased to offer a funding opportunity to qualifying organizations within its service area. CHNA 20 anticipates that $50,000 in overall grant funding will be awarded to eligible candidates in this funding cycle. Community Grants up to $5,000 will be available to support programs, events and sustainable change projects, which will serve and benefit CHNA 20 communities and their residents for the project period of July 1, 2015 to June 30, 2016. The Blue Hills Community Health Alliance (CHNA 20) is one of 27 Community Health Network Areas across Massachusetts. The following communities comprise CHNA 20: Braintree, Canton, Cohasset, Hingham, Hull, Milton, Norwell, Norwood, Quincy, Randolph, Scituate, Sharon and Weymouth. The mission of CHNA 20 is to empower our communities to achieve their best quality of health and wellness through education and information while improving access to care and services.
GRANT PRIORITY AREAS AND FUNDING GOALS After careful review of our community health needs assessment data as well as consideration of several new initiatives, CHNA 20 will focus on two priority areas for the 2015 Community Grant program: 1. Access to Care 2. Chronic Disease & Wellness To that end, CHNA 20’s 2015 Community Grant funding goals are to: 1) Improve access to care in our service population; especially to those most vulnerable; “Vulnerable” may be defined as low income, high-risk for a particular health indicator, racially or ethnically marginalized or experiencing barriers to services due to language or other significant socio-economic factor;
2) Engage community partners to focus on chronic disease* & wellness, including but not limited to, cancer and its related causes such as diabetes, obesity, nutrition, lack of physical activity and heart disease; * Chronic disease is defined as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both. In addition to comprising physical medical conditions, chronic conditions also include problems such as substance abuse and addiction disorders, mental illnesses, dementia and other cognitive impairment disorders, and developmental disabilities (http://www.hhs.gov/ash/initiatives/mcc/mcc_framework.pdf).
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3) Support efforts to develop and foster collaborations and partnership across agencies and communities by promoting awareness of health issues within the region; 4) Fund projects that show value to the community beyond the life of the one year award period.
ELIGIBILITY Organizations and entities must meet the following criteria to be eligible.
Applicants must submit Intent to Apply by 5 PM Friday, May 15, 2015 (template provided on page 6.) Applicants must be from non-profit organizations and/or public entities including municipalities, schools, non-profit health institutions, services and community groups. o Certificate of Tax Exempt status (current IRS letter confirming the taxexempt status: 501C (3), 509(a) of the lead organization, group, or fiscal sponsor. An organization/entity must serve one or more of the 13 CHNA 20 communities. Eligible organizations/entities may apply for more than one community grant to fund more than one program, event or sustainable change project. However, o only one grant per organization/entity is eligible to be funded. o
projects will not be funded for more than two consecutive years.
o CHNA 20 will evaluate all proposals to ensure that resources are shared equitably among its partner communities and the eligible organizations/entities. THE FINAL EQUITABLE ALLOCATION OF GRANT FUNDS WILL BE DETERMINED BY THE REVIEW TEAM AND CHNA 20 STEERING COMMITTEE.
CHNA 20’s funding source is through the Determination of Need Community Health Initiatives (DoN), which are required and overseen by the Massachusetts Department of Public Health. Our generous funders include: Dana-Farber Cancer Institute, South Shore Hospital, and Steward Health Care
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APPLICATION INSTRUCTIONS: Intent to Apply must be submitted prior to the full application by Friday, May 15, 2015 (template and instructions provided on page 6.) Only required documents and attachments will be accepted for review. All applications must be typed. Please use no smaller than 12-point font. Collectively, responses to the narrative (questions 1-9) may not exceed 4 single spaced pages. The page count does NOT include the Intent to Apply, cover sheet, signature page, certificate of tax-exempt status, workplan template and budget template. Attach current IRS letter confirming the tax exempt status: 501c (3), 509(a) of the lead organization, group or fiscal sponsor Please submit entire application as ONE document (tax exempt form can be sent separately). Please include in the subject line: CHNA 20 Community Grant Application 2015 AN ELECTRONIC COPY of the application must be emailed to chna20@baystatecs.org Arlene Goldstein, CHNA 20 Program Manager by 5:00 PM on Friday, June 5, 2015.
IMPORTANT DATES AND INFORMATION SESSION FUNDING OPPORTUNITY ANNOUNCEMENT AND RELEASE: April 27, 2015 INFORMATION SESSION*: Friday, May 8 9:30-11:30 Quincy Innovation Center, 180 Old Colony Avenue, Quincy INTENT TO APPLY DUE: Friday, May 15, 2015 APPLICATIONS must be received via email by 5:00 PM on Friday, June 5, 2015 AWARD DECISIONS will be emailed on Friday, June 19, 2015 Programs, upon award verification will receive funds on July 1, 2015 *CHNA 20 reserves the right to amend this RFA as indicated including any of these dates as deemed necessary. Any change will be communicated immediately to the membership and all grant applicants.
*CHNA 20 highly encourages participation in the facilitated Information Session by at least one member of the potential applicant's organization or group. An overview of the funding opportunity will be provided as well as the "mechanics" for crafting a successful proposal. There will be an opportunity for networking, questions & answers, and collaboration building. Questions and Answers from the Information Sessions will be posted to the CHNA 20 website http://www.CHNA20.org
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2015 COMMUNITY GRANT, CHNA 20 GRANT COVER SHEET PROJECT TITLE: 2 -3 sentence description of the proposed project
LEAD APPLICANT ORGANIZATION OR GROUP: Mission Statement
EXECUTIVE DIRECTOR/PRINCIPAL: Address, city, state, zip: Phone: (
)
Email: Email:
GRANT PROPOSAL CONTACT: Address, city, state, zip : Phone: (
)
Email:
COLLABORATIVE PARTNER ORGANIZATIONS: _____________________________________________________________________________ Amount of Funding Requested: $________________________________________________
NAME OF FISCAL CONTACT PERSON: Address, city, state, zip : Phone: (
)
Email: Note: If your group has a fiscal agent/conduit other than the applicant named above, please provide the name and complete contact information of the fiscal agent/conduit:
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2015 CHNA 20 COMMUNITY GRANT APPLICATION Please respond to the following items (1-9 below) using no more than 4 pages. The Intent to Apply, cover sheet, signature page, certificate of status, budget and workplan are not included in the 4-page limit.
PROPOSAL NARRATIVE 1. What is the problem you plan to address through this project? 2. How does the problem relate to one or more of the Community Grant’s goals? (Refer to pages 1& 2) 3. What evidence (data) can you provide of the problem and the impact on the community you plan to serve? 4. Who will the project serve? Please describe: a. The targeted priority population (e.g., gender, age, race, ethnicity, socioeconomic status), b. The geographic community that will be impacted by your program and c. The estimated number of people your program will reach. (Please specify the CHNA 20 cities and towns your project will be working with in the grantfunded program.) 5. What are your goals and objectives? (What do you hope to achieve?) 6. Summarize the key activities you will complete throughout the course of this project. 7. Briefly describe any meaningful collaborations and partnerships you plan to utilize to help achieve your projects goals. 8. Describe how you will measure the success of your project. (How do you intend to track and evaluate your project?) a. How will you identify and address challenges? 9. What is your plan for sustainability for the proposed project? (How will this project continue to impact your community beyond the funding period?)
Note: Applicants should submit proposals that demonstrate the use of methods proven through research OR promising innovative practices that are linked to existing research. Applicants should show how the use of these evidence-based methods will lead to enduring outcomes on one or more of CHNA 20’s focus areas.
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ATTACHMENT 1: INTENT TO APPLY Interested applicants MUST submit Intent to Apply by May 15, 2015 by 5PM. Submitting this documentation is necessary for CHNA 20 administrative purposes. Please include all the items listed below: Name of Project
Lead Organization Name:
Lead Organization Address:
Name of Project Contact Person and Title:
Phone: Email: Are you a 501c (3) or 509 (a)?
Yes
No
Tax ID Number of Organization OR of Organization’s Fiscal Sponsor: Fiscal Sponsor:
Names of Collaborating Partner(s)
Please submit your Intent to Apply electronically by Friday, May 15, 2015 by 5PM to Arlene Goldstein, CHNA 20 Program Manager at chna20@baystatecs.org
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ATTACHMENT 2: COMMUNITY GRANT PROJECT WORKPLAN Be as specific as possible. An example has been provided to help guide your responses. Example Program Goal: Reduce BMI by improving the healthy eating habits of students K-5. Objective
Actions
1. Increase the number of fruit and veggie servings available at lunch for K-5 students
Meet with food service department to develop action plan
Timeline July-Sept 2014
Outcome (s) A written plan to include more fruits and veggies at lunch
Outcome Measure New menu items added more fruit and veggie options
2.
3.
4.
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ATTACHMENT 3: COMMUNITY GRANT BUDGET TEMPLATE AND NARRATIVE 1. List and explain all project costs to be funded. 2. Provide a 1 paragraph budget explanation (in the space below the grid) that provides further clarity and detail of costs. Item
Amount requested in this application
Other Funding Sources
Sources and amounts of inkind support
Total Program/Project Costs
Personnel Staff Consultant Supplies & Printing Equipment related to program (tape recorder, camera) Administration /Overhead (May not exceed 10% of budget requested) Other expenses (list and explain)
Total $
$
$
$
*Special note: 1. Grant funds cannot be used to fund direct staff time for an existing program (programs must demonstrate a new or expanded component: funding cannot be used solely to supplement existing salaries.) 2. CHNA 20 COMMUNITY Grants are not made directly to individuals, nor are they made for; general marketing and promotional videos; endowments; independent research; seed money, advertisements, sponsorships, or fund raising events; or for lobbying or other items.
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SIGNATURE PAGE AND POST AWARD EXPECTATIONS/OBLIGATIONS CHNA REPORTING AND PARTICIPATION:
Each grant recipient will be responsible for providing a mid-year and final report. Dates and reporting templates will be provided to recipients at time of the award.
A representative(s) from the grant recipient organization must attend the CHNA Grant Showcase to give a brief presentation about their project. In addition, attendance at a least one other CHNA sponsored is required.
PROMOTION AND FUNDING ACKNOWLEDGMENT:
Grant recipients consent to allow CHNA 20 to publicize their grant awards and projects. Such promotion may include names, website postings, fliers, photography/videography, news coverage, and distribution of project summary reports. Grant recipients will be notified in advance of promotional activities involving their organizations and programs. CHNA 20 will work with grant recipients to assure that privacy and confidentiality are appropriately safeguarded.
Grantees are asked to acknowledge the support of CHNA 20 in publicity and communications regarding the funded project.
I certify that the information in this application is accurate and true to the best of my knowledge and that the grant our agency may receive from CHNA 20 will be used in accordance with granting guidelines as indicated in this application E-Signature: Title: Date: For additional information please email, Arlene Goldstein, CHNA 20 Program Manager at CHNA20@baystatecs.org
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COMMUNITY GRANT APPLICATION CHECKLIST Please check all items once you have included them in your grant application. Please note: all items listed below are required. Coversheet Proposal narrative with responses to questions 1-9 (not more than 4 pages in length) Attachment 2: Community Grant Project Workplan Attachment 3: Community Grant Budget Template and Narrative Signature Page and Post Award Expectations/Obligations Page Documentation of Tax Exempt Status or, if applicable, verification of designated Fiscal Agent and 501(c)3 or 509(a) of that agent Electronic copy submitted with all sections included in one document (pdf format preferred) Community Grant Application Checklist
Please do not attach additional documents or letters of support Proposals must be submitted electronically in PDF format to Arlene Goldstein at CHNA20@baystatecs.org with CHNA 20 Community Grant Application 2015 in the “SUBJECT” line. All proposals must be received by June 5, 2015 by 5:00 PM EST. No late submissions will be accepted.
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