2019 Community Grant Policies & Guidelines

Transcription

1 2019 Community Grant Policies & Guidelines The mission of the Delta Dental of Arkansas Foundation (Foundation) is to improve the oral health of Arkansans through dental education, prevention and treatment. Each year, the Foundation provides financial support to organizations to help further our mission, and we encourage community-based oral health programs in Arkansas to apply for grants for programs designed to improve oral health. Community Grants seek to increase access to oral health care in underserved areas by funding preventative services or treatment for individuals of all ages, ethnicities, gender, and socio-economic status in Arkansas grants will be awarded up to $30,000; however, the Foundation retains the authority to award larger grants at its discretion. In carrying out the mission, the Foundation established the following guidelines: GRANT CYCLE TIMELINE Grant Application Deadline: August 31, 2018 Grant Recipients Announced: November December 2018 Grant Funding Cycle: January December 2019 ELIGIBILITY REQUIREMENTS Provide all information requested in the application prior to the established deadline. Serve underserved Arkansans. Propose a project that clearly advances oral health initiatives in Arkansas. Nonprofit or community organizations holding a current tax-exempt status under Section 501(c)(3) of the Internal Revenue Code. Recognized governmental entities including state, county, or city agencies such as health departments. Educational facilities, such as K-12 public, private, or charter schools or school districts and higher education institutions. GRANT RECIPIENT REQUIREMENTS Sign a grant agreement prior to receiving funds. Submit a report no later than 60 days upon completion of project or prior to being considered for future funding, whichever comes first (Foundation will supply reporting form). Work with the Foundation to promote grant partnership through media opportunities, organization materials, social media, etc. Agree to join the Delta Dental of Arkansas Foundation grantee network and attend annual network meeting in January 2019 (Date TBA). GRANT REQUEST REQUIREMENTS Only one application per organization will be reviewed each grant cycle. Must include a signed copy of the provided grant application cover sheet. Narrative and budget sections must not exceed 6 pages. Please use 12-point font or larger and use 1 margins. Use bold section and subject headings. Place page numbers in the bottom right corner of each page.

2 GRANTS TYPICALLY NOT FUNDED INCLUDE REQUESTS FOR Individuals. Indirect costs, excess administrative and salary costs, utilities, wages/salary, fringe benefits, travel, or incentives/gifts. Fundraising events. Private foundations and endowments. Deficit financing and debt retirement. Projects that will not be implemented within one year. Programs that discriminate on the basis of race, national origin, gender, religion, age, disability, political beliefs, sexual orientation, or marital or family status. Grant applications will be judged based on the innovativeness of the proposed project, its potential impact on the oral health of Arkansans and the subjective analysis of the Delta Dental of Arkansas Foundation s staff, grant review committee, and board of directors. The Foundation s funding decisions are final and shall not be subject to appeal. Certain grants include specific reporting requirements, schedules, and systems that may vary based on the funding level. Please review the grant terms and conditions carefully before applying. Thank you for your interest in the Delta Dental of Arkansas Foundation Community Grant Program. We commend you for your efforts to improve oral health care throughout the state of Arkansas. For more oral health news and information, visit DeltaDentalAR.com and follow us on Twitter and Facebook For questions contact: Weldon Johnson, Executive Director (501) wjohnson@deltadentalar.com Kara Wilkins, Foundation Coordinator (501) kwilkins@deltadentalar.com

3 FOR INTERNAL USE ONLY Application #: 2019 Grant Application (PLEASE TYPE OR PRINT CLEARLY) ORGANIZATION Name: Address: City: State: ZIP: Telephone: Website: GRANT CONTACT Name: Title: Telephone: Mobile: PROGRAM INFORMATION Program title: Item(s) grant is requested to fund: Grant amount request: Total budget for program: Service area (city, county, statewide): Approximate number of children (0-18 years old) to be served: Approximate number of adults to be served: 21-65: Homebound/Aging Adults: Oral Health Education PROGRAM FOCUS Oral Health Preventive Care (fluoride treatments, sealants, screenings, etc.) Oral Health Treatment (treating cavities, gum disease, etc.) Other (please explain): Are you a Minority or Women Owned Business or Organization? Yes No I certify to the best of my knowledge that all information in this grant application is correct and I have read and agree to the terms and conditions as outlined. Authorized signature and title Date To apply for a Community Grant, please submit an electronic copy of the grant application and other required materials in a PDF to Foundation@deltadentalar.com NO LATER THAN 5PM ON AUGUST 31, 2018.

4 2018 GRANT SUBMISSION GUIDELINES Please address the following sections in narrative format. Bold all sections and subject headings as shown below and add page numbers. Your application must be submitted as a single PDF file to the Delta Dental of Arkansas Foundation. Section 1: Executive Statements (1/2 page maximum) Program Objectives: Describe the objectives of the program, including the expected outcome, estimate of number of adults and children it will serve, etc. Request Statement: Items the grant will fund (equipment, supplies, salary, etc.) Section 2: Description of Your Organization (1 page maximum) Please do not provide information about non-dental aspects of your program. Background: Provide a brief historical perspective of your organization and any previously successful oral health programs your organization completed. Structure: Describe your organizational structure, governance and provide a numerical breakdown of full-time, part-time and volunteer workers that will support this program. Section 3: Program Description (2 page maximum) Demographics Served: Provide demographic information of the population targeted including age, ethnicity, financial status, etc. Please include your organization s non-discrimination policy. Service Area: Describe the geographical areas this program will serve in Arkansas (cities, counties, statewide). NOTE: Foundation grants are designated to support programs within the state of Arkansas. Program Plan: Provide a simple work plan listing key activities, anticipated time frame and responsible party(ies). Desired Outcomes: Describe how your program will improve oral health in your service area. Support: Describe your organization s relationship with other community efforts (if applicable), and how your organization is coordinating with other agencies. Section 4: Program Budgets (1 page maximum) 2018 grants will be awarded up to $30,000; however, the Foundation retains the authority to award larger grants at its discretion. Using the table format identified in Exhibit A, please itemize program costs, describe how individual amounts were calculated and identify the proposed funding source. If requesting funding for equipment and/or supplies, please include a quote in your supporting documents from the dental supply company and identify any discounts given. Section 5: Past Funding (1/2 page maximum) Please indicate if your organization received financial support from Delta Dental or the Delta Dental of Arkansas Foundation in the last three years. If yes, please describe the program results (i.e., number of patients treated, procedures, etc.), and how the grant funds were used to help achieve those results. This information is crucial for all returning grant applicants. Section 6: Evaluation (1/2 page maximum) The Delta Dental of Arkansas Foundation will provide a grant evaluation reporting form for all grantees. Describe how and when your organization will evaluate the overall success of this program. At a minimum, your evaluation plan should demonstrate how your organization will quantify the number of adult patients and children (ages 0-18) served due to the Foundation s funding.

5 Section 7: Recognition (1/2 page maximum) Describe how and when the Delta Dental of Arkansas Foundation s grant will be recognized. Section 8: Supporting Documents Please include the following: IRS 501(c)3 tax exemption letter (not required for public or government entities such as schools) If requesting funding for equipment and/or supplies, please include a quote from the dental supply company and identify any discounts given. Copy of your organization s operational budget (income and expense) Please provide a percentage breakdown of your organization s operating revenue using the chart below: OPERATING REVENUE PERCENT Private Insurance Patient Fee Government Funding (Medicaid/Medicare) State Grants/Contracts Local Government Foundation/Corporate Grants Organization Fundraising (events, bequests, donations) Investment Income Other (describe): TOTAL (must equal 100%)

6 EXHIBIT A: Sample Program Budget DDAR FOUNDATION REQUEST OUTSIDE FUNDING TOTAL WAGES/SALARY Project Coordinator (200 $15.00/hour) $3,000 $3,000 Administrative Assistant (20 $8.00/hour) $160 $160 FRINGE BENEFITS FICA/ Social Security (15.3% of Wages/Salary) $484 $484 State Unemployment Tax Assessment (3.3%) $104 $104 Workmen s Compensation Insurance (1.4%) $44 $44 TRAVEL Local Mileage (450 $0.35 per mile) $156 $156 EQUIPMENT One (1) Chair $2,500 $2,500 $5,000 One (1) Delivery Unit $3,000 $3,000 One (1) Operating Room Light $1,500 $1,500 PROJECT SUPPLIES Dental Sealant Material (250 $6.00 each) $1,500 $1,500 Consumables (700 $3.60 each) $2,520 $2,520 INCENTIVES/GIFTS Meals for Volunteers $7.50 each) $150 $150 OTHER (BE SPECIFIC) Newspaper ads (Once weekly for six $12.00) $72 $72 TOTAL $11,020 $6,670 $17,690 NOTE: Marketing/promotional items should be within reason and may be restricted if it is excessive in relation to the project or program. Please do not include costs for marketing materials that can be provided by the Delta Dental of Arkansas Foundation (e.g. toothbrushes, coloring books, etc.).