Section 1: Basic Information (25 points total)

A. Contact Information

Include the contact information for the lead organization responsible for this application. You will have the opportunity to list any partners in a subsequent section.
Include the contact information for the lead organization responsible for this application. You will have the opportunity to list any partners in a subsequent section.
Format Example: https://www.hektoen.org/

B. About Your Proposal

If you answered "no," your project is ineligible for this funding opportunity. Refer to "Eligibility Requirements" in the RFP (pg. 3-4).
Answer required if applying for Option 2: Providing Community Supports and participating on one of the regional Learning & Action Networks.
1500 character limit (about 250 words or 1/2 page)
1500 character limit (about 250 words or 1/2 page)

C. Applicant: Organizational Summary, Capacity and Commitment

1500 character limit (about 250 words or 1/2 page)
1500 character limit (about 250 words or 1/2 page)
While there will be an initial payment once contract is executed, community contractors for Option 1 will be paid the remaining funds at end of project period and for Option 2 will be allocated funding on a monthly reimbursement basis.
1500 character limit (about 250 words or 1/2 page)

Section II: Proposed Project (60 points total)

In the following section, please enter your answers into the boxes below, following the character limits listed.

A. Issue Statement - 1 Page Maximum (10 points)

Explain how COVID-19 or related factors have an impact on the population(s) your organization intends to reach and how the community support(s) selected address the issues. Use data-driven statements to support your explanation.
3000 character limit (1 page maximum)

B. Current Efforts - 2 Page Maximum (15 points)

Projects are to maximize their impact by expanding on current efforts. Describe up to 3 outcome goals of your current efforts; 3-5 accomplishments between March to August 2020; 3-5 barriers you have faced over this time period; and, what resources you have in place to support your current efforts (e.g. staffing, partnerships, funding, etc.).
6000 character limit (2 page maximum)

C. Proposed Outcomes & Activities - 2 Page Maximum (20 points)

Based on the community support(s) selected, provide a narrative that: 1) Describes how you plan to expand your current activities; 2) Identiies measureable outcomes you intend to achieve. In all cases, please indicate how you intend to measure the specified outcome and specify any barriers you anticipate to achieving your outcomes; and, 3) Outlines specific activities to successfully develop and implement your community support(s).
6000 character limit (2 page maximum)

D. Partnerships - 1 Page Maximum (10 points)

Projects are to maximize their impact by working with partners. Provide a description of organizations with whom your organization plans to collaborate, ways in which you have worked together previously (if applicable) and the role they would play to ensure successful implementations on the proposed community support(s). Note: You will need a signed letter of support from a minimum of three partner organizations.
3000 character limit (1 page maximum)

E. Sustainability - 1/2 Page Maximum (5 points)

Describe the lasting impact of the activities you propose beyond the completion of the community contract; and concrete steps your organization and its partners will take to ensure continued collaboration beyond the project period. Note: There is no match requirement for this program. However, leveraging other resources and related on-going efforts to promote sustainability is encouraged.
1500 character limit (about 25 words or 1/2 page)

Section III: Work Plan & Budget (10 points total)

A. Work Plan

Identify below specific action steps, the responsible organization, and the expected month of completion towards successfully implementing the community support(s).
Click or drag a file to this area to upload.
Please attach completed Work Plan. Please save document as Work Plan_Organization Name.

B. Budget

Please enter the requested budget lines and attach the budget template for community supports.
Click or drag a file to this area to upload.
Please attach completed budget. Please save document name as Budget_Organization Name.

Section IV: Letters of Support (5 points)

Please attach electronic copies of all letters of support from partners listed in Section II that clearly identifies their respective role in the project. Note: You will need a signed letter of support from a minimum of three partner organizations.
Click or drag files to this area to upload. You can upload up to 5 files.
Please save documents as LOS_Applicant Name1, LOS_Applicant Name2, LOS_Applicant Name 3, etc.

Section V: Certification

Applicants must complete, sign, and upload the form below with their proposal.
Click or drag a file to this area to upload.
Please save document as: Certification_Organization Name.