Minority Health Research and Education Grant Program. Diversity Conferences. Fiscal Years

Transcription

1 Minority Health Research and Education Grant Program Diversity Conferences Supported by investment proceeds from the Permanent Fund for Minority Health Research and Education Fiscal Years Deadline for Applications March 1, 2006 Texas Higher Education Coordinating Board P. O. Box Austin, Texas Published December 2005

2 Texas Higher Education Coordinating Board (Board) Robert W. Shepard, Chairman Neal W. Adams, Vice Chairman Lorraine Perryman, Secretary Laurie Bricker Jerry Farrington Paul Foster George Louis McWilliams Nancy R. Neal Lyn Bracewell Phillips Curtis Ransom A.W. Whit Riter, III Harlingen Bedford Odessa Houston Dallas El Paso Texarkana Lubbock Bastrop Dallas Tyler Board Mission The mission of the Texas Higher Education Coordinating Board is to provide the Legislature advice and comprehensive planning capability for higher education, to coordinate the effective delivery of higher education, to efficiently administer assigned statewide programs, and to advance higher education for the people of Texas. Board Philosophy The Texas Higher Education Coordinating Board will promote access to quality higher education across the state with the conviction that access without quality is mediocrity and that quality without access is unacceptable. The Board will be open, ethical, responsive, and committed to public service. The Board will approach its work with a sense of purpose and responsibility to the people of Texas and is committed to the best use of public monies. The Texas Higher Education Coordinating Board does not discriminate on the basis The Texas Higher Education Coordinating Board does not discriminate on the basis of race, color, national origin, gender, religion, age or disability in employment or the provision of services. 1

3 Minority Health Research and Education Grant Program Diversity Conference Table of Contents I. Summary of Grant Program Program Overview Grant Competition Schedule Pages 1-4 II. Instructions Definitions of Key Terms Document Format and Submission Standards Retention Study Timeline and Outline of Data Director Activities Cost-Sharing Indirect Costs Budget Restrictions Other Grant Restrictions/Conditions Subcontracts with the Grantee Institution Instructions For Completing the Application Forms 5-12 III. Evaluation of Applications General Selection Criteria Five-Step Grant Award Process Appendices Application Forms 1-7 2

4 Minority Health Research and Education Grant Program-DC Page 1 This packet contains instructions and forms for submitting a grant application to the Texas Higher Education Board s (Board) Minority Health Research and Education Grant Program Diversity Conference (MHGP-DC) competition. To be eligible for MHGP-DC, institutions must submit applications to the Board as specified in these instructions and in any other instructions that the Board may distribute before the submission deadline. Electronic copies of these instructions and forms can be found at the Board s website at Program Overview Name General Purpose Of MHGP Minority Health Research and Education Grant Program DC To provide funding to eligible institutions of higher education to conduct research and educational programs on public health issues affecting one or more minority groups in Texas. MHGP Authority Texas Education Code, Eligible / Grantee Institutions Focus and Scope of the Competition Public and private accredited general academic and health-related institutions, and Centers for Teacher Education, that conduct research or educational programs that address minority health issues or form partnerships with minority organizations, colleges, or universities to conduct research and educational programs that address minority health issues. Other institutions and agencies of higher education as defined by Texas Education Code (6) are not eligible to submit a grant application but may be a compensated partner to an eligible institution. The Board is seeking through this grant competition eligible institutions to plan and host a maximum of six statewide or regional diversity conferences on increasing the number of students from underrepresented groups in health-related academic programs. The Board is soliciting proposals for conferences that address one or more disciplines within the following health-related areas: Allied Health Biomedical Sciences Dentistry Medicine Nursing Pharmacy Public Health A conference proposal in the area of Allied Health, Biomedical Sciences or Public Health must encompass multiple academic disciplines (e.g. An applicant must propose a diversity conference for all Allied Health disciplines or one encompassing physical therapy, occupational therapy, and respiratory therapy). Proposals may also address more than one health-related area (e.g., a diversity conference in Dentistry and Medicine) but only with prior approval from the Board. The grantee institution would be responsible for all aspect of planning and conducting the conference.

5 Minority Health Research and Education Grant Program-DC Page 2 Conference Goals The major goals of the diversity conferences are to: (1) present research on promoting diversity in health-related education; (2) provide opportunities for teachers, faculty, and/or students with similar interests to learn and discuss new ideas for promoting healthrelated careers, student preparation, student success, and related issues in a collegial and engaging environment; and (3) foster collaboration among multiple levels of health-related education. Required Elements of the Conference The diversity conferences shall: General Logistics be held in a hotel or conference facility (on or off campus); be scheduled between February 1, 2007 and August 31, 2007 and not conflict with other major conferences, holidays, and Spring Break; require a conference registration fee not to exceed $75.00 per person; qualify participants for continuing education credit (as applicable to the discipline), either through the eligible institution or other sponsoring entity; and result in published conference proceedings, documenting presentations, discussions, findings and strategies for implementation. The grantee institution will be responsible for compiling, printing and distributing the proceedings within 60 days from the conclusion of the diversity conference. Program Design have a nationally-known keynote speaker discuss one broader or several narrower topics concerning student recruitment and/or student success; and have one general session to review Texas demographics of the student population, practitioner population, and the general population within the context of the specific health-related area; have concurrent breakout sessions to develop and discuss ideas, study findings, and formulate recommendations and strategies on specific issues related to improving the diversity of students and/or practitioners in the specific health-related area;

6 Minority Health Research and Education Grant Program-DC Page 3 Preferred Elements of the Conference The grantee institution should have a steering committee with at least one representative from practice and/or from another level of education within the health-related area. The conference program should include: o juried presentations from academic programs in Texas; o invited presentations from individuals in other states; o exploration of related issues of particular interest to Texas such as recruiting and retaining under-represented faculty, and recruiting and retaining under-represented practitioners; and o interactive strategies to promote discussion and collaboration among individual faculty, practitioners, employers and/or students. General Selection Criteria Competitive. Designed to award grants to eligible institutions that offer the best overall value to the state. Selection criteria shall be based on: 1. program quality (in this case, referring to the conference program) as determined by peer reviewers; 2. impact the grant award shall have on public health issues affecting one or more minority groups in the state; 3. cost of the proposed program; and 4. other factors, including ability to conduct program, state and regional needs and priorities, whether the eligible institution has been designated as an Historically Black or Hispanic-Serving institution by the U.S. Department of Education, the qualifications and past experience of the eligible institution and any partner in planning and conducting similar programs, how well the proposed content of the program meets the goals and elements stated in the grant application instructions. Grant Period The grant begins April 1, 2006 (tentative date of contracts) and ends August 31, Available MHGP Funds An estimated $600,000 is available to fund a maximum of six diversity conferences during the biennium. Size of Grant Minimum award: $50,000 for each fiscal year ending August 31. Award Maximum award: $125,000 for each fiscal year ending August 31. As a result, the eligible institution may request no less than $100,000 and no more than $250,000 for the grant period. Grant Payments In quarterly payments following each quarter of a fiscal year (payments in June 2006, September 2006, December 2006, March 2007, June 2007, September 2007).

7 Minority Health Research and Education Grant Program-DC Page 4 Reporting Requirements The grantee institution shall submit three reports to the Board: a 9-month interim report on January 1, 2007 (to be presented in Austin at Board offices); a conference paper within 60 days from the conclusion of the conference, and a final financial statement within 90 days from the conclusion of the conference. Carryover Funds At the Board s discretion, unencumbered funds may carry over from one fiscal year to another within the grant period. Unencumbered funds may not carry over beyond the grant period unless as specified under Unspent Funds. Unspent Funds After the grant period ends, the eligible institution shall reimburse the Board for any unspent funds from the MHGP-DC grant and registration fees. The eligible institution may retain any unspent funds earned from exhibitor fees or sponsorships unless otherwise specified in an agreement between the institution and any exhibitor or sponsor. Application Deadline More Information Applications must be received in paper format in the Academic Affairs and Research Division at the Board s Office at 1200 E. Anderson Lane, Austin, Texas, by 5 p.m., March 1, 2006 to be considered for funding. Contact Ms. Chris Fowler, Program Director Academic Affairs and Research Division, at 512/ or by at Chris.Fowler@thecb.state.tx.us Grant Competition Schedule March 1, 2006 March 6, 2006 March 20, 2006 April 1, 2006 Applications are due. Applications are distributed to peer reviewers. Commissioner announces grant award. Contract is signed.

8 Minority Health Research and Education Grant Program-DC Page 5 Definitions of Key Terms Board -- The Texas Higher Education Board. Commissioner -- The Commissioner of Higher Education. Eligible or grantee institution -- A public or private SACS accredited general academic or healthrelated institution, or a Center for Teacher Education, located in Texas, that conducts research or educational programs that address minority health issues or that forms a partnership with a minority organization, college, or university to conduct research or educational programs that address minority health issues. Two-year colleges and universities, including junior and community colleges, state colleges and technical colleges, and other agencies of higher education as defined by Texas Education Code, (6) are not eligible to submit a grant application but may be a compensated partner to an eligible institution. Grant period -- The grant period is from April 1, 2006 (tentative date of the award contract) to August 31, Program director -- The principal educator responsible for planning and conducting the diversity conference. The person shall be a full-time faculty member in a tenured or tenure-track position at the eligible institution. One additional co-program director may be named from the eligible institution if the person meets eligibility requirements and shares responsibility for the program. Document Format and Submission Standards Writing Style Format Copies Number of Submissions Write clearly and concisely. Avoid jargon and terms not commonly known. Write for an academic administrator or public health professional. Spell out terms the first time with abbreviations in parentheses. Use 8 ½ x 11 white paper with 11- or 12-point type. Stay within the margins on form pages. For Forms 2 and 3, use 1" side and top margins on continuation pages. Number pages. Adhere to page limits under Instructions For Completing the Application Forms, pages Order Forms as 1, 2, 3, 4, 5, 6 and 7, followed by letters of support, and then, appendices. Staple all pages of the application in the upper left corner. Submit 1 signed original and 4 copies of each application. An eligible institution may submit only one application for the MHGP-DC grant competition. A program director may receive only one MHGP grant during the biennium.

9 Minority Health Research and Education Grant Program-DC Page 6 Submit to: Deadline Ms. Chris Fowler, Program Director Academic Affairs and Research Division Texas Higher Education Board U.S. Mail Mail Service Delivery P.O. Box or E. Anderson Lane Austin, TX Austin, TX Applications must be received in paper format in the Academic Affairs and Research Division at the Board s Office at 1200 E. Anderson Lane, Austin, Texas, by 5 p.m., March 1, 2006 to be considered for funding. Cost-sharing Institutions may report other sources of support for the diversity conference on Form 1, Line 4b. Form 5, Box H and Form 6, Box H. An institution that reports a significant commitment of costsharing for the program will receive points in the review process. Eligible institutions may include all costs (including in-kind contributions) in any amount reported as cost-sharing, except indirect costs. Indirect Costs Indirect costs may be included in the MHGP-DC budget in an amount not to exceed 5 percent of total direct costs. Budget Restrictions Institutions may include all reasonable costs in the proposed program director s MHGP-DC budget with a few exceptions. The following kinds of costs shall not be included in the proposed budget: Capital equipment. Construction or remodeling of facilities. Foreign travel. Indirect costs that exceed more than 5 percent of the total direct costs of the MHGP-DC budget. Salaries or other stipends that are calculated at a higher pay rate than that which an individual (or similar position) normally receives. (Costs for staffing should reflect salaries of the eligible institution appropriate to the tasks that will be performed, and the length and time spent on the program.) Tuition and fees for students. Salary incentives and salary increases (routine or otherwise) for faculty and staff. Cell phones.

10 Minority Health Research and Education Grant Program-DC Page 7 The following kinds of costs shall not be charged to the grant award without prior approval from the Board: Domestic travel not specifically identified in the approved grant application. Salaries and fringe benefits for positions other than those positions specifically identified in the approved grant application. Budget transfers across Budget Categories A, B, C, and D that exceed cumulatively 25 percent of the total award during the grant period. Other Grant Restrictions/Conditions The Board and the grantee institution shall agree to the following restrictions and conditions. The Board: may visit the grantee institution to review the program director s activities, and the institution s financial records for the grant; may suspend or terminate the grant if the institution fails to comply with the terms of the contract or if the program director leaves the institution without a suitable replacement approved by the Board; and shall not be held liable in the event of damages to persons or property which may occur in the course of activities conducted as a result of the grant. The grantee institution shall: ensure that all personnel associated with the grant abide by all state and federal regulations for academic activities. Institutions should review the application with legal counsel before submitting applications; ensure that all personnel associated with the grant abide by the institution s intellectual property policy; ensure that no person is excluded from participation in, denied benefits of, or otherwise subjected to discrimination under the grant on the grounds of race, color, national origin, religious affiliation, disability or gender; have a financial management system that provides appropriate review and approval of expenditures of grant funds and monitoring of program performance. The institution shall have its financial records and other materials pertinent to the grant available for review and audit by the Board, the State Auditor and other auditors for a period of three years following the end of the grant period; notify the Board of any potential conflicts of interest that arise prior to or during the grant period; notify the Board if the program director leaves the grantee institution or otherwise relinquishes active direction of the program; expend funds in accordance with Budget Restrictions, page 6-7. Subcontractors shall abide by the same restrictions; request Board approval of fund transfers across Budget Categories A, B, C, and D that exceed cumulatively 25 percent of the total award during the grant period; receive quarterly grant payments from the Board; submit a 9-month interim report on January 1, 2007; a conference paper within 60 days from the conclusion of the conference, and a final financial statement within 90 days from the conclusion of the conference.

11 Minority Health Research and Education Grant Program-DC Page 8 The grantee institution shall: (cont.) return all unexpended funds to the Board within 90 days of the expiration of the grant; return or pay back the grant funding if the State of Texas is required to return funds as a result of federal legislation regarding the subject matter of the case styled, The State of Texas v. The American Tobacco Co., et al., No.5-96CB-91, in the United States District Court, Eastern District of Texas; and acknowledge Board support on conference-related activities by including language to that effect on related publications and other materials. Sample language: This material is based upon work supported by the Minority Health Research and Education Grant Program, a grant program funded by proceeds from the State s Tobacco Lawsuit Settlement and administered by the Texas Higher Education Board. Subcontracts with the Grantee Institution After the grant awards are announced, any subcontractor(s), must sign a contract(s) with the grantee institution. The services described in the contract must be consistent with those stated in the grant application and outlined in the final conference program. Each contract shall state that the subcontractor agrees to abide by the same grant requirements and conditions as the grantee institution. The grantee institution must file a copy of the subcontract(s) with the Board before MHGP-DC funds may be disbursed to the subcontractor(s). Subcontractor(s) must understand that acceptance of state funds under a contract(s) with the grantee institution, as contractor, acts as acceptance of the authority of the State Auditor s Office, or any successor agency, to audit or investigate the expenditure of state funds under the contract(s). The subcontractor(s) must agree to cooperate fully with the State Auditor s Office or its successor, including providing all records requested. The grantee institution, as contractor, must ensure that this clause concerning the authority to audit state funds received indirectly by the subcontractor(s) through the contractor and the requirement to cooperate is included in any subcontract(s) it awards. Instructions For Completing The Application Forms Content for the application forms is explained below in the order in which the forms should be submitted in the application. Applications that exceed the maximum page lengths may not be considered for MHGP-DC funding. (Shaded areas on the forms are for Board use only). Form General Description / Specific Instructions 1 Cover Page Maximum Length 1 page Complete all sections of the form except where shaded. Important Points Box 5 and 6. Totals should sum to amount in Box 4. Line a.

12 Minority Health Research and Education Grant Program-DC Page 9 Form General Description / Specific Instructions 1 Cover page (cont.) Boxes 7, 8 and 10. The form must be signed and dated by the program director(s) and the institution s representative for sponsored programs. Box 9. The individual named as the contact person should be able to answer general questions about the application and serves as liaison to the program director on any specific question. Board staff will contact this person first with any questions about the application. Maximum Length 1 page 2 Description of Services and Qualifications 8 pages The template for this form should be used for page 1 only. Continuation pages should have 1" margins. Pages should be numbered. Text should be in 11- or 12-point type. Please respond to the following 5 questions: o What are the major issues or problems in improving the diversity of students in your health-related area? (1) How would your plans for the conference address those issues? o o o How do your plans for the conference address the goals and required and preferred elements outlined on pages 1-3 of the grant application instructions? What experience/resources do you/your institution and any partner(s) have in planning and conducting professional conferences? What would be the expected outcomes of the conference? How would those outcomes lead to new strategies for improving the diversity of students? 3 Conference Program Outline 4 pages The template for this form should be used for page 1 only. Continuation pages should have 1" margins. Pages should be numbered. Text should be in 11- or 12-point type. Provide a schedule of Conference activities (including meals and social events) as it would appear in a conference program. Include as much detail about those activities and activity leaders as possible in the space provided.

13 Minority Health Research and Education Grant Program-DC Page 10 Form General Description / Specific Instructions 4 Timeline Maximum Length 2 pages Provide an outline of the key activities involved in planning and conducting the diversity conference in chronological order. Each entry should include: (1) A span of dates for accomplishing the activity; (2) A brief description of the activity and method of delivery; (3) Identification of the entity, person(s) or positions responsible for completing or supervising the activity (often shown in parentheses following the brief description); and (4) The expected outcome(s). While an eligible institution has some discretion as to which activities to highlight on the timeline, the timeline should have entries for signed agreements with major subcontractors, any significant hires, and scheduled reports to the Board. 5 Budget 1 page This form summarizes costs that the program director should explain in greater detail on Form 6: Budget Detail. Important Points Box G. Total should equal the amount on Form 1, Box 4a. Box H. Total should equal the amount on Form 1, Box 4b. Signatures of the program director and institutional representative are not required at the initial application stage of the grants competition. 6 Budget Detail Review Budget Restrictions, pages 6-7, before completing this form. 4 pages Boxes may be added or deleted on the form under each budget category to conform to the structure of the budget. For example, if most of the budget is in Personnel, additional boxes can be added to explain costs within that category. A bulleted line should represent a specific cost (e.g., the program director s salary) or a major subset of a particular budget category (e.g., secretarial staff salaries). The box below the bulleted line should be used to explain how the cost was calculated and to summarize the function or importance of that expense to the success of conference-related activities. Note: Board staff may cut or reduce budget items that are not adequately justified.

14 Minority Health Research and Education Grant Program-DC Page 11 Form General Description / Specific Instructions 6 Budget Detail (cont.) Important Points Maximum Length 4 pages In determining all costs for the program, note the length of each fiscal year during the grant period: FY2006: April 2006 August 2006 (5 months) FY2007: September 2006 August 2007 (12 months) Categories A-G. The information should answer the following question: How do the costs in the Budget reflect how the program director and other faculty and staff would plan and conduct the conference? Category A. Personnel should include (unless a part of costsharing) a separate bulleted line and box for the salary of the program director. Other faculty and staff may merit a separate bulleted line and box or may be consolidated under a subcategory of salaries (e.g. secretarial support). Fringe benefits may be included in those calculations or reported separately as another subcategory. Salary increases may not be included in the budget. Category B. Travel should include (unless a part of cost-sharing) a separate bulleted line and box for the program director to travel to Austin to present the nine-month interim report to Board members and/or Board staff. Other travel may vary. Category C. Subcontracts should be itemized by contractor or function. Category E. Boxes A, B, C and D in each year should equal the total amount shown in Box E for each year. The sum of Box E for both years should equal the amount on Form 5, Box E. Category G. The sum of Box G for both years should equal the amount on Form 1, Box 4a and Form 5, Box G. Category H. The information should answer the following question: What, if any, costs would the eligible institution, et al., contribute to planning and conducting the conference? These are costs incurred by the institution, other benefactors, and the program director that are not a part of the requested MHGP-DC budget. The sum of both years should equal the amount on Form 1, Box 4b, and Form 5, Box H. See Cost-sharing, page 6, for more information about what are permissible costs to this category. Total Funding for Program. The sum of both years should equal the amount on Form 1, Box 4c.

15 Minority Health Research and Education Grant Program-DC Page 12 Form General Description / Specific Instructions Maximum Length 7 Resume Attach a 1- to 2-page resume for each program director as Form 7. The resume does not need to adhere to Format standards, page 5. 2 pages per program director Letter of Support 2 pages The program director(s) must include a letter of support from the chief academic officer of the institution. The letter must be on the institution s letterhead. Contents also must verify any cost-sharing reported by the institution to receive full credit in the peer review process. Appendices 6 pages The appendices do not need to adhere to Format standards, page 5. Examples of common appendix materials: Letters of support from benefactors who pledge cost-sharing (Letter is required to receive full credit for cost-sharing in the peer review process.) Additional letters of recommendation and support. Other information that addresses the program director s/institution s qualifications to plan and conduct the conference. Samples of previous conference programs conducted by the institution.

16 Minority Health Research and Education Grant Program-DC Page 13 General Selection Criteria The Board will award grant funding based on a competitive process, designed to provide the best overall value to the state. Selection criteria shall be based on: program quality; impact the grant award shall have on public health issues affecting one or more minority groups in the state; cost of the proposed program; and other factors, including ability to conduct program, state and regional needs and priorities, whether the eligible institution has been designated as an Historically Black or Hispanic-Serving institution by the U.S. Department of Education. Five-Step Grant Award Process 1. Preliminary Screening of Applications. The Board staff will screen applications to determine if all requested information is complete and adheres to application requirements. An application must be received or hand-delivered with proper authorization from the program director(s) and the institution s representative for sponsored programs by 5:00 p.m. before or on March 1, 2006 to qualify for further consideration. Qualified applications will be forwarded to reviewers for evaluation. 2. Review. The Commissioner will select qualified individuals to evaluate the quality of applications. Reviewers shall not evaluate any applications for which they have a conflict of interest. The Board staff will provide written instructions and training for peer reviewers. Reviewers will evaluate applications and assign scores based on award criteria. All evaluations and scores of the peer review panel are final and will be based solely on the information provided in the written application. The reviewers will evaluate each application based on criteria established by rule for the Minority Health Research and Education Grant Program. Those criteria may be adapted for this grant competition to more effectively judge the merits of proposed applications. Generally, the criteria are: Significance of program Resources to perform program Program design Cost-sharing Cost-effectiveness Evaluation and expected outcomes 3. Staff Recommendations. Board staff will rank each application based on points assigned by reviewers and recommend a priority ranked list of applications to the Commissioner. 4. Commissioner s Funding Decisions. Funding recommendations to the Commissioner will consist of the most highly ranked and recommended applications up to the limit of available funds. In making funding decisions, the Commissioner also may consider state and regional needs and priorities. Individual funding decisions will be based on the written information provided on the application. If available funds are insufficient to fully fund a proposal, staff will negotiate with the applicant to

17 Minority Health Research and Education Grant Program-DC Page 14 determine if a lesser amount would be acceptable. If the applicant does not agree to the lesser amount, the staff will negotiate with the next applicant on the ranked list. The Commissioner anticipates announcing grant awards by March 20, Grant Contract and Payments. The grantee institution shall sign a contract with the Board, agreeing to the grant restrictions and conditions, pages 6-8, and any other requirements of the Board and the State of Texas. Because earnings from the Permanent Fund are distributed quarterly by the Comptroller of Public Accounts to the Board, the grantee institution shall receive payments following each quarter of the fiscal year from the Board. Unencumbered funds may not carry over beyond the grant period (ending August 31, 2007).

18 Minority Health Research and Education Grant Program DC Cover Page Program # 1. Institution 2. Conference Title 3. Conference Partners and Sponsors 4. Proposed Funding a. MHGP-DC $ b. Cost-sharing $ c. Total $ 5. FY2006 Request (April 1, 2006 Aug. 31, 2006) $ 6. FY2007 Request (Sept. 1, 2006 August 31, 2007) $ 7. Typed Program Director s Name 8. Co-Program Director s Name (from same institution) Phone FAX Phone FAX Address Address Mailing Address Mailing Address Signature Signature 9. Contact Person s Typed Name and Title and Office of Sponsored Programs Phone Mailing Address Address 10. Authorized Institutional Representative s Typed Name, Title and Endorsement Name Title I certify that the statements herein are true, complete, and accurate to the best of my knowledge. I further certify that if program funds are awarded, this institution accepts the obligation to comply with terms and conditions set by the Texas Higher Education Coordinating Board. Signature Date

19 Minority Health Research and Education Grant Program DC Description of Services and Qualifications Program # Program Director and Institution Keyword Description of Conference (max. 5 words or phrases) Narrative (See Questions, page 9)

20 Description of Services and Qualifications, cont.

21 Minority Health Research and Education Grant Program DC Conference Program Outline Program # Program Director and Institution

22 Conference Program Outline, cont.

23 Minority Health Research and Education Grant Program DC Timeline Program # Program Director and Institution Dates Activity and Method of Delivery (Person Responsible) Outcome(s)

24 Timeline, Cont. Dates Activity and Method of Delivery (Person Responsible) Outcome(s)

25 Minority Health Research and Education Grant Program DC Budget Program # Program Director and Institutional Affiliation A. Personnel (show number of people in brackets) Two-Year Totals 1. ( ) Program Director /Co-Program Director 2. ( ) 3. ( ) Subtotal - Salaries and Wages Fringe Benefits ( %) Total Salaries, Wages, Fringe Benefits B. Personnel Travel Total Personnel Travel C. Subcontracts for Services 1. Conference Facility 2. Speakers 3. Other Total Subcontracts D. Other Direct Costs 1. Materials, Supplies and Non-Capital Items 2. Other Total - Other Direct Costs E. TOTAL DIRECT COSTS For Two-Year Grant Period F. INDIRECT COSTS For Two-Year Grant Period not to exceed 5% of Line E. G. TOTAL MHGP REQUEST For Two-Year Grant Period H. Cost-sharing For Two-Year Grant Period $ Program Director s Signature (required only prior to funding) Date I hereby certify that I have read and agree to comply with all conditions of this grant and agree to return to the Coordinating Board any funds not expended in compliance with those conditions. Institutional Representative s Signature (required only prior to funding) Date

26 Minority Health Research and Education Grant Program DC Budget Detail Program # Program Director s Name and Institutional Affiliation Budget Detail By Category FY2006 FY2007 A. Personnel Personnel Total $ $ B. Personnel Travel Personnel Travel Total $ $ C. Subcontracts for Services Subcontract Costs Totals $ $

27 D. Other Direct Costs Other Direct Costs Totals $ $ E. Total Direct Costs $ $ F. Total Indirect Costs $ $ G. Total MHGP Request $ $ H. Cost-sharing $ $ Total Funding For Program $ $

28 Minority Health Research and Education Grant Program DC Resume This is not a template but a placeholder. Program Director(s) resume(s) is added as Form 7."

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