Community Grants Request for Applications National Capital Area

Community Grants Request for Applications National Capital Area Nancy G. Brinker promised her dying sister, Susan G. Komen, she would do everything in her power to end breast cancer forever. In 1982 that promise became Susan G. Komen for the Cure and launched the global breast cancer movement. Today, Komen for the Cure is the world s largest grassroots network of breast cancer survivors and activists fighting to save lives, empower people, ensure quality care for all and energize science to find the cures. Thanks to events like the Komen Race for the Cure, we have invested more than $1.9 billion to fulfill our promise, becoming the largest source of nonprofit funds dedicated to the fight against breast cancer in the world. For more information about Susan G. Komen for the Cure, breast health or breast cancer visit www.komen.org. Komen is working to reduce rates of late stage diagnosis and mortality with an emphasis on eliminating breast cancer disparities. With funds raised at the Komen Global Race for the Cure, grants will be made to support high impact breast cancer programs in the National Capital area that address the priorities described in the Community Profile, a needs assessment of Washington, D.C. and seven surrounding counties. STATEMENT OF NEED The findings from the 2010 National Capital Area Community Profile revealed two main themes throughout the area. First, education efforts need to do more than raise awareness about breast cancer; they must empower and equip people to take action. Specifically, programs need to provide in-depth education on screening, breast cancer and resources. In addition, they should be tailored to specific groups, culturally competent, and provide consistent, clear messages that lessen fear and confusion. The second theme is a lack of continuity of care throughout the continuum of care for women who are uninsured and underinsured. The continuum of care includes screening, diagnosis, treatment and follow-up care. Throughout the continuum, coordination within and between providers is needed to ensure that all patients receive timely, high-quality and culturally-competent care and that no patient is lost to follow-up. Strong preference will be given to those organizations providing programs and services in the target areas and to those partnerships that include organizations in the target areas. The 2010 Community Profile Report is on our website www.komen.org. Drawing from the profile Susan G. Komen for the Cure has identified the following geographic target areas and priorities for the 2012 National Capital Area Grants Program: National Capital Area RFA, Page 1 of 10

Geographic Target Areas (in alpha order) Arlington County, VA Prince George s County, MD Prince William County, VA Wards 7&8 in Washington, DC Priority I- Provider Education Increase provider cultural competency, understanding of breast cancer screening recommendations supported by Susan G. Komen for the Cure, and knowledge of various referral processes to better navigate their patients through the continuum of care. Preference will be given to programs that can demonstrate provider behavior change that leads to increased referral rates and screening rates within an organization s patient population. Providers can include navigators, physicians, nurses, office staff, community health workers, and other office staff or volunteers who work with patients and can improve patient care. Partnerships and/or collaborations are encouraged but not required. Example: Training for office staff and health care providers to streamline and improve the screening referral process. Priority II- Public Education Implement breast cancer education programs to include tailored messages, understanding of the disease, and survivorship as well as ensuring that the program is culturally competent. All education programs must demonstrate how their activities will lead to action, such as participants obtaining regular mammograms. Partnerships and/or collaborations are encouraged but not required. Example: Culturally-tailored education and outreach project that directly links individuals to breast health services and follow-up. Priority III- Partnerships to address Fragmentation Reduce fragmentation and enhance the health care system s capacity to screen and provide follow-up care in the National Capital Area. Programs will create continuity between referral, screening, diagnosis, and treatment within the region. Partnerships and/or collaborations are required and groups must provide evidence of collaboration. The organizations involved must demonstrate how they can address this priority by doing something different than what currently exists and how they can work together to change the system. Evidence of a less fragmented system could include decreased time from screening to diagnosis and/or decreased time between diagnoses to treatment. Komen for the Cure supports partnership in which responsibilities, privileges and power are shared. Example: A process or system that increases the percentage of patients who enter, stay-in or progress through the continuum of care. National Capital Area RFA, Page 2 of 10

Important Dates: Application Deadline: Friday, August 26, 2011, 5:00 PM EST All applications must be submitted via email to nationalcapitalarea@komen.org. Each attachment should be clearly identified with the organizations name (or abbreviation) underscore, then the application component (i.e. cover page, program description, budget, and supporting documentation). All applications must be submitted electronically in Microsoft Word format. No mail or fax copies will be accepted. Inquiries should be directed to nationalcapitalarea@komen.org or by calling (972) 701-2130. Please allow adequate time before the application deadline for response to any inquiry. Attending at least one training session is highly encouraged. Both trainings will cover the same topics. Technical Assistance Training 1: Tuesday, July 12, 2011 from 9am-3pm Training will focus on priorities established by the 2010 Community Profile, program evaluation, writing strong goals and objectives, logic models, and project plans. All applicants are strongly encouraged to attend. Please RSVP to nationalcapitalarea@komen.org if attending. Technical Assistance Training 2: Thursday, August 4, 2011 from 9am-3pm Training will focus on priorities established by the 2010 Community Profile, program evaluation, writing strong goals and objectives, logic models, and project plans. All applicants are strongly encouraged to attend. Please RSVP to nationalcapitalarea@komen.org if attending. Technical Assistance Sessions: Friday, August 5, 2011 from 9am-5pm Applicants can schedule 30 minute meetings with the Director, Community Grantmaking to discuss questions and ideas related to their proposed application. Please send an email to nationalcapitalarea@komen.org to schedule a time. Any organization applying for Priority III must attend a technical assistance session. Award Notification: December 2011 Anticipated Funding Start: January 1, 2012 GUIDELINES FOR APPLICANTS Failure to adhere to these guidelines will result in delayed processing or refusal of the application. Qualifications Applicants must ensure that all past and current Komen-funded grants or awards are up-to-date and in compliance with Komen requirements. National Capital Area RFA, Page 3 of 10

Lead agencies must be federally tax-exempt, non-profit organizations located in or providing services to one or more of the following locations: o Washington, DC o Montgomery County, MD o Prince George s County, MD o Alexandria City, VA o Fairfax County, VA o Loudoun County, VA o Arlington County, VA o Prince William County, VA Funding Information: Organization with a current community grant that continues through all or parts of 2012 are not eligible to apply for funding. An organization may serve as the lead agency (agency that will manage the funds and report on the project) on only one application. The lead agency applying for priority three may request up to $1,000,000 over four years on behalf of the coalition, collaboration or partnership. The project period must be four years. The lead agency applying for priority one or two may request up to $200,000 over two years. The project period must be two years. Organizations may request funds for screening; however, organizations must demonstrate that Komen is not the sole funder for the screening program and explain how the organization (s) will leverage the funds to ensure maximization of screening resources. Restrictions Project must be specific to breast health and/or breast cancer (e.g. if a project is a combined breast and cervical cancer project, funding may only be requested for the breast cancer portion). Indirect costs (costs the organization would incur regardless of the project such as rent, telephone, internet, etc.) if applicable, should be no more than 20% of direct costs. Salaries, if requested, are for personnel related to this project only and not general work of applicant. Funds may not be used for: o Medical or scientific research (costs for program evaluation are allowed) o Equipment o Paid media (film, radio, web sites, etc.) o Scholarships or fellowships o Construction or renovation of facilities o Political campaigns or lobbying Educational Materials Susan G. Komen for the Cure is a source of information about breast cancer for people all over the world. To reduce confusion and reinforce learning, we require that National Capital Area RFA, Page 4 of 10

grantees provide educational messages and materials that are consistent with those promoted by Komen for the Cure, including promoting the message of breast selfawareness and knowing your risks for breast cancer. Education programs promoting monthly breast-self examination will not be funded. Please visit the following website before completing your application and be sure that your organization can agree to promote these messages: http://ww5.komen.org/breastcancer/breastselfawareness.html Komen for the Cure grantees are eligible to receive preferred pricing for Komen educational materials. Komen for the Cure materials should be used and displayed whenever possible. To view our educational materials, visit http://www.shopkomen.com/ Selection Criteria - Applications will be judged on the following criteria: Impact: Will the project have a substantial positive impact on increasing the percentage of people who enter, stay in, or progress through the continuum of care? Will the project have a substantial impact on the priority selected? How closely does the project align with the funding priorities stated in the RFA? Does the project have a sufficient and documented plan to evaluate its impact? Feasibility: How likely is it that the objectives and activities will be achieved within the scope of the funded project? Is the project well planned? Is the budget appropriate and realistic? Does the budget justification explain in detail the reasoning and need for the costs associated with the project? Capacity: Does the organization, Project Director and his/her team have the expertise to effectively implement all aspects of the project? Is the organization respected and valued by the target population? Is it culturally competent? Collaboration: Does this project enhance collaboration among organizations with similar or complementary goals? Are the roles of the partners appropriate and relevant? Sustainability: Is the project likely to be sustained? Are partnerships likely to be sustained past project period? Is the impact likely to be long-term? APPLICATION INSTRUCTIONS Format All applications must be written in English and assembled in the format and order described below. Please use all forms included in this RFA. Sections must be properly National Capital Area RFA, Page 5 of 10

labeled and submitted single-spaced on 8½ inch by 11 inch. Font size should be no smaller than 12-point. Use Arial or Times New Roman only. All pages must be numbered sequentially. The maximum file size is 10 MB. Organizations may want to zip large files. Please keep proposals to the page limits and characters stated below. Excess pages may be removed prior to review. Cover Page (form attached) Complete the attached cover page including an abstract (project summary). The abstract should be limited to 1,500 characters, including spaces and punctuation (approximately 225 words). The abstract should provide a brief description of the proposal including the following: 1) the purpose of the program; 2) a description of key activities; 3) a summary of evaluation methods; and 4) the likely impact of the program. The signature of approving institutional personnel, other than the project director, is required. The cover page must be submitted as a Microsoft Word document and the file name in the following format: OrganizationName_Cover Page.doc. (e.g. FreeClinic_Cover Page.doc). Organization Summary (form attached) Complete the attached organization summary page. It should include a brief description of the following: 1) organization s history and if your program is part of a larger organization, an explanation of the mission of the larger entity and your relationship to it; 3) the mission of the organization; 4) the current programs and accomplishments; 5) explanation of how your organization seeks to be diverse and inclusive; 6) number of paid full time staff, volunteers and total annual organization budget. This organization summary must be submitted as a Microsoft Word document and the file name in the following format: OrganizationName_Organization Summary.doc. (e.g. FreeClinic_Organization Summary.doc). Program Description The program description must be submitted as a Microsoft Word document and the file name in the following format: OrganizationName_Program Description.doc. (e.g. FreeClinic_Program Description.doc). Organization Capacity (limit 3,500 characters) Explain why the applicant organization is best-suited to lead the project and accomplish the goals and objectives set forth in this application Describe evidence of success in delivering breast health/cancer services to the proposed population Describe fiscal capability to manage the delivery of the proposed goals and objectives and ensure adequate measures for internal control of grant dollars. Statement of Need (limit 3,500 characters) Describe the population to be served Describe evidence of the risk/need within that population Provide statistics specific to the target population National Capital Area RFA, Page 6 of 10

Project Description (limit 3,500 characters) Explain how the project s goals and objectives, as outlined in your Project Work Plan, addresses one or more of the priorities outlined in the Affiliate s Community Profile/Statement of Need. Collaboration (limit 3,500 characters) Describe the roles and responsibilities of all organizations or entities participating in the project. Explain how the collaboration strengthens the project and why these organizations are best suited to carry out the project and accomplish the goals and objectives set forth in this application. Sustainability (limit 3,500 characters) What resources (financial, personnel, partnerships, etc.) will be needed to sustain the effort over time? How will those resources be secured by the end of the funded project period? What are your organization s plans to support the project lead to implement, manage and oversee all aspects of the proposed project? What efforts will you take to communicate this project to leadership to ensure buy-in? Describe the organization s current financial state. Has your organizational budget increased or decreased from last year? Please explain why. Evaluation (limit 3,500 characters) Describe in detail how the organization (s) will measure achieving project goals and objectives and how will the impact of the project on the priority selected be assessed. Describe the evaluation expertise that will be available for this purpose. What resources are allocated for evaluation in the project budget? o A strong evaluation plan measures both the quantity and quality of strategy implementation and outcomes. i. Impact Evaluation: Assesses the changes that can be attributed to a particular intervention, such as a project, program or policy. Impact Evaluation helps us to answer key questions such as, what works, what doesn t, where, why and for how much? ii. Process Evaluation: Assesses the delivery of programs. Process evaluation verifies what the program is and whether it is being implemented as designed. It answers the questions of what is delivered in reality and where are the gaps between program design and delivery? Project Work Plan (form attached) National Capital Area RFA, Page 7 of 10

Complete the attached project work plan exactly as it appears and submit as a Microsoft Excel document. Describe the goals and objectives. Objectives should be written as SMART objectives. Specific to what you want to achieve Measurable how much do you want to achieve? Achievable - are the objectives realistic? Results-oriented measures outcomes, not activities Timely By when do you want to achieve the objective? Goals are defined in the context of this grant application as broad statements of the ultimate result of the program being undertaken. o For example: Increase provider knowledge of the screening guidelines in Prince George s County. Objectives are defined in the context of this grant application as the following something that is measurable, time-specific result that the organization expects to accomplish as part of this grant. Objectives are specific approaches to achieve the goal. o For example: Decrease by x% the proportion of patients with an abnormal mammogram who are lost to follow-up. For each goal and objective, please include: Timeline for completion Intended intervention to accomplish Individual at your organization responsible Number of individuals you intend to serve through the intervention A description of methods and techniques you will use to evaluate effectiveness The project work plan must be completed exactly as it appears and be submitted as a Microsoft Excel document and the file name in the following format: OrganizationName_ProjectWorkplan.xcel (e.g. FreeClinic_ProjectWorkplan.xcel). Budget (form attached) Provide a detailed total program budget. All funding for this program, including other sources of funding will be included. For each line item in the budget, provide a brief description of how the funds will be used and why they are programmatically necessary. The budget must be submitted as a Microsoft Excel document and the file name in the following format: OrganizationName_Budget.xcel (e.g. FreeClinic_Budget.xcel). Attachments 1. Evaluation forms, surveys, logic model, etc. related to demonstrating the effectiveness of your program as defined in your project work plan. 2. Information regarding Key Personnel For key personnel that are currently employed by the applicant, provide a resume or curriculum vitae. For new or vacant positions, provide job descriptions (Two page limit per individual). National Capital Area RFA, Page 8 of 10

3. Letters of support, collaboration, MOU, etc. 4. Proof of Non-Profit Status To document you federal tax-exempt status, attach your determination letter from the Internal Revenue Service. Evidence of state or local exemption will not be accepted. Please do not attach your Federal tax return. All attachments must be clearly labeled. These documents do not have a file type restriction but should be saved in the following format: OragnizationName_LogicModel (e.g. FreeClinic_LogicModel) SUBMISSION CHECKLIST Before submitting your application packet please be sure the following items are included: Cover Page (form provided) Is it saved as a Microsoft Word document with the file name in the following format: OrganizationName_Cover Page.doc. (e.g. FreeClinic_Cover Page.doc)? Organization Summary (form provided) Is it saved as a Microsoft Word document and the file name in the following format: OrganizationName_Organization Summary.doc. (e.g. FreeClinic_Organization Summary.doc)? Program Description Is it saved as a Microsoft Word document and the file name in the following format: OrganizationName_Program Description.doc. (e.g. FreeClinic_Program Description.doc)? Is it limited to 8 pages? Did you answer all the questions outlined in the Request For Applications? Project Work Plan (form provided) Is it saved as a Microsoft Excel document and the file name in the following format: OrganizationName_ProjectWorkplan.xcel (e.g. FreeClinic_ProjectWorkplan.xcel). Is it completed exactly as it appears in the Microsoft Excel Worksheet? Did you include only one goal per tab? Are your objectives S.M.A.R.T? Budget (form provided) Is it saved as a Microsoft Excel document and the file name in the following format: OrganizationName_Budget.xcel (e.g. FreeClinic_Budget.xcel). Did you provide justification for each line item in your budget? Attachments Key Personnel- Is it clearly labeled and named as follows: OrganizationName_KeyPersonnel National Capital Area RFA, Page 9 of 10

Proof of Non-Profit Status- Did you include your determination letter from the IRS? Is it clearly labeled and named as follows: OrganizationName_ProofNP Letters of Support- Did you include? Are they clearly labeled and named as follows: OrganizationName_LetterofSupport Evaluation Forms- Did you include relevant forms, surveys, logic model, etc? Are they clearly labeled and named as follows: OrganizationName_LogicModel National Capital Area RFA, Page 10 of 10