Letter Of Intent (LOI) Community Breast Health Grants Program

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1 1 Letter Of Intent (LOI) Community Breast Health Grants Program ABOUT SUSAN G. KOMEN LOI Submission Deadline is Friday, November 3, 2017 at 5:00 PM EST Susan G. Komen is the world s largest breast cancer organization, funding more breast cancer research than any other nonprofit outside of the U.S. government while providing real-time help to those facing the disease. Komen has set a Bold Goal to reduce the current number of breast cancer deaths by 50 percent in the U.S. by Komen was founded in 1982 by Nancy G. Brinker, who promised her sister, Susan G. Komen, that she would end the disease that claimed Suzy s life. Komen Greater New York City is working to better the lives of those facing breast cancer in the local community. Through events like the Komen Greater NYC Race for the Cure, Komen Greater NYC has invested $51.4 Million in community breast health programs in five boroughs of New York City, Long Island, Westchester, and Rockland Counties and has helped contribute to the more than $920 million invested globally in research. For more information, call (212) or visit FUNDING OPPORTUNITIES Susan G. Komen Greater New York City (Komen Greater NYC) is soliciting applications from non-profit organizations that have current or proposed breast health programs within the five boroughs of New York City, Long Island, Westchester and Rockland Counties. Partnerships and collaborative projects that provide opportunities for greater leveraging of philanthropic investments and that demonstrate the potential to create measurable impact are encouraged. The purpose of the Community Breast Health (CBH) Grants Program is to support evidencebased, culturally competent community programs that provide the medically underserved with access to breast health education, and treatment and support services. Grant requests for Community Breast Health Programs may be submitted for a maximum of $65,000. A formal Letter Of Intent is a mandatory requirement in order to be considered for Komen Greater NYC grant funding. We recognize that at the LOI phase of the application process, some of the program information may be preliminary in nature and subject to modification prior to or at the time of the proposal submission. The purpose of the LOI is to provide Komen Greater NYC staff with a brief overview of the proposed CBH program prior to submission of a full application. Staff members will review LOIs and notify organizations by November 10, 2017 if they are invited to submit a full proposal. Please read the RFA carefully for more detailed instructions about full applications for Community Breast Health grants. Komen Greater NYC has identified the following funding priorities for Community Breast Health Programs: Priority will be given to applicants that demonstrate benefit undocumented immigrants, rarely and never screened individuals, *under/uninsured populations, immigrants of African descent, African-Americans, and Hispanic/Latino residing in one or more of the following target

2 communities: Bronx Kings Richmond Rockland Westchester Suffolk 1. Patient Navigation Patient navigation is a process by which a trained individual- patient navigator- guides patients through and around barriers in the complex breast cancer care system. The primary focus of a patient navigator is on the individual patient, with responsibilities centered on coordinating and improving access to timely screening, diagnostic and treatment services tailored to individual needs. Patient navigators offer interventions that may vary from patient to patient along the continuum of care and include a combination of informational, emotional, and practical support (i.e., breast cancer education, counseling, care coordination, health system navigation, and access to transportation, language services and financial resources). About 70% of Komen Greater NYC s funding will go to the evidence-based and culturally competent patient navigation programs that ensure timely screening and diagnostic services that benefit high risk populations residing in high priority areas. Lay navigators and nurse navigators should work closely to supply assistance and navigation services to overcome the complexities of the health system and barriers to breast cancer care in clinical and non-clinical settings. Uninsured status is one of the most common causes of barriers experienced by high priority populations. Lay navigators should be locally recruited and work in close collaboration with target communities and clinical staff. Lay navigators should provide bilingual/bicultural educational materials approved by Komen. Evidence based materials are available in different languages on Komen s website: Lay and nurse navigators should facilitate referral to free or low cost screening, diagnosis, and treatment services through selecting health insurance plans and completing necessary applications. Lay and nurse navigators should make sure to reduce loss to follow-up especially after an abnormal screening test and/or cancer diagnosis. Lay and nurse navigators should make sure that women have the skills to self-manage their treatment plans. Patient navigators should remain current with the available and new resources, referral information, and training materials. 2. Treatment and Support Services About 20% of Komen Greater NYC funding will support evidence-based programs that focus on support services: 2

3 Evidence-based programs provide crucial support services and regular follow-ups that remove barriers to care and improve adherence to treatment. The support services that eliminate barriers to care include, but are not limited to, transportation, financial assistance and psychosocial services for patients in active treatment and those living with metastatic disease. 3. Breast Cancer Education Evidence-based and culturally competent education programs increase knowledge and understanding of the communities about breast health care and facilitate referrals for diagnostic workups and treatment. The education program should also aim at increasing the knowledge of providers about local breast care services. About 10% of Komen Greater NYC funding will support breast health education programs: Provider Focused: Programs that enhance provider collaboration in health facility shortage areas within the target communities that help to connect women to available, high quality resources. Programs and initiatives should facilitate referral between primary care physicians, radiologists, surgeons, and oncologists by collaborating with Komen GNYC partners and stakeholders. Programs that increase knowledge and understanding about local breast care services such as CSP, Emergency Medicaid, the New York State of Health and the Medicaid Cancer Treatment Program for providers that provide services to residents in the priority communities. Patient Focused: Programs that provide breast cancer education in one-on-one and/or group settings. Projects must be designed to result in documented age-appropriate, breast cancer action (e.g., getting a screening mammogram, obtaining recommended follow-up after an abnormal mammogram). Breast cancer education projects must include Komen s breast self-awareness messages and provide evidence of linkage to local breast cancer services. Health fairs and mass media campaigns are not evidence-based interventions and will not be accepted. Provider focused and patient focused programs should have measurable outcomes on behavioral change in facilitating and seeking breast health care services, respectively. QUALIFICATIONS AND ELIGIBILITY To be eligible to participate in Komen Greater NYC s LOI process, organizations must meet all of the following criteria: Individuals are not eligible to apply. Applications will only be accepted from a non-profit organization with 501(c)3 status (such as an educational institution, hospital or other medical facility, or a community organization) or a local/state government located in or providing services to one or more of the following locations: o o 3 Five boroughs of New York City (Bronx, Kings, Queens, Manhattan, and Richmond Counties) Long Island (Nassau and Suffolk Counties)

4 o o Westchester County Rockland County Proposed projects must be specific to breast health and/or breast cancer and address the priorities identified in the Affiliate s 2015 Community Profile. If a project includes other health issues along with breast cancer, such as a breast and cervical cancer project, funding may only be requested for the breast cancer portion. All past and current Komen-funded grants or awards to applicant are up-to-date and in compliance with Komen requirements. Applicant has documentation of current tax-exempt status under the Internal Revenue Service code. If applicant, or any of its key employees, directors, officers or agents is convicted of fraud or a crime involving any other financial or administrative impropriety in the 12 months prior to the submission deadline for the application, then applicant is not eligible to apply for a grant until 12 months after the conviction. After such 12 month period, applicant must demonstrate in its application that appropriate remedial measures have been taken to ensure that any criminal misconduct will not occur. INELIGIBLE REQUESTS Applicants may not request funding for any of the following activities or expenditures: Medical or scientific research Scholarships or fellowships Construction or renovation of facilities Political campaigns or lobbying Endowments Debt Reduction Indirect costs these include those that are not direct expenses related to your program; for example, rent, telephone, or internet costs. LETTER OF INTENT (LOI) SUBMISSION REQUIREMENTS If your program meets our eligibility requirements, please review the instructions carefully and prepare a LOI. LOI must be submitted electronically by 5:00 PM EST on November 3, 20017; submissions that arrive after that time will not be considered. Please submit the LOI as a PDF or Word document attached to an cover letter and send it to Shakiba Muhammadi, Manager of Grants and Public Policy, at smuhammadi@komennyc.org. If you have questions, feel free to call Ms. Muhammadi at

5 LETTER OF INTENT (LOI) PREPARATION GUIDELINES LOI s must be submitted by the individual authorized to sign for the organization. The LOI must not exceed two (2) pages (excluding the cover page and checklist). Please remember to submit ALL required documents. Please do not include any other attachments. Fax copies will not be accepted. Failure to adhere to these guidelines will result in delayed processing or refusal of the application. Inquiries should be addressed or directed to Shakiba Muhammadi, Manager of Grants and Public Policy, at mailto:smuhammadi@komennyc.org or (Please allow adequate time before the deadline for responses to any inquiry) **Additional resource to assist you in writing your LOI can be found here: 5

6 CBH Letter of Intent Checklist The following is a checklist of the LOI requirements for your request to be complete and considered for funding. PROJECT DIRECTOR: Please initial each line to certify understanding and acknowledgement of Komen Greater NYC LOI regulations. 1. Letter is submitted by 5:00 PM EST on November 3, I understand that the Grant Period for this LOI is April 1, 2018 to March 31, Project is specific to breast health and/or breast cancer. 4. Applicant is a US nonprofit (federally tax-exempt) organization, e.g. nonprofit organizations, educational institutions, government agencies, and Native American tribes. 5. Services are provided in the Komen Greater NYC service area, which is comprised of the five boroughs of New York City, Rockland, Westchester, Nassau and Suffolk Counties. 6. If you have received a grant from Komen Greater NYC in the past, you are current on your final reports, and all past and current Komen-funded grants or awards are up-to-date and in compliance with Komen requirements. Please note: The LOI is the first step in the application process. Receipt of your LOI will be acknowledged. If Komen Greater NYC finds the request appropriate and within the scope of our funding priorities, an invitation to submit an application will follow by November 10, 2017.

7 CBH Letter of Intent Cover Page Letters Must Be Submitted by November 3, 2017 by 5:00 PM EST The Grant Period for this LOI is April 1, 2018 to March 31, 2019 Please Indicate the Type of Application Primary Focus (Funding request must comprise more than 50% of proposed activities and program budget in this area) Secondary Focus, (please check one if applicable) Patient Navigation Treatment and Support Education and Outreach Patient Navigation Treatment and Support Education and Outreach TITLE OF PROJECT (5 WORDS OR LESS) ESTIMATE OF TOTAL DOLLAR AMOUNT REQUESTED (MAXIMUM: $65,000) INSTITUTION OR ORGANIZATION STREET ADDRESS CITY, STATE, ZIP PROGRAM DIRECTOR NAME AND TITLE PHONE NUMBER ADDRESS SIGNATURE & TITLE OF APPROVING PERSONNEL (OTHER THAN PROGRAM DIRECTOR) PRINT NAME & TITLE OF APPROVING PERSONNEL (TYPED)

8 CBH Letter of Intent Form Letters Must Be Submitted by November 3, 2017 by 5:00 PM EST The Grant Period for this LOI is April 1, 2018 to March 31, 2019 A Letter of Intent must demonstrate understanding of the requirements of the grant program for which you wish to apply. To complete a LOI, be sure you are familiar with the guidelines of the grant program. Please make certain that your request addresses the Komen Greater New York City s identified needs and/or funding priorities. Please answer the questions below (not to exceed the two [2] page maximum). 1. Please provide a brief description of your organization and why you are positioned to submit this letter of intent. 2. Briefly describe the project. This should include an overview of what your organization proposes to do, how much you are requesting, how the proposed project relates to the Affiliates identified priorities and the timeline for completing the project. 3. Briefly describe the need this project will be addressing, how your organization identified the need and how this project will contribute to eliminating the need. Be sure to include any pertinent statistics or research. 4. Briefly describe your project evaluation plans. Be sure to include your goals and objectives and how you will know you have accomplished them. Projected outcomes should be clear and measureable. 5. Identify the partner organizations that are necessary to complete the project. 6. If this project has been funded in the past, please summarize the number of years funded and the successes the program has shown. Has the program been capable of finding opportunities for improvement in this project and modifying the project?