March of Dimes Washington State Community Grants Program. Community Award Application

Similar documents
March of Dimes Chapter Community Grants Program Letter of Intent (LOI)

March of Dimes Chapter Community Grants Program. Request for Proposals (RFP)

Community Grants Program for Idaho, Montana, North Dakota, South Dakota and Wyoming

March of Dimes Louisiana Community Grants Program Request for Proposals (RFP) Application Guidelines for Education and Incentive Projects

Request for Proposals (RFP) for CenteringPregnancy

March of Dimes - Georgia. State Community Grants Program. Request for Proposals (RFP) March of Dimes- Georgia

March of Dimes Chapter Community Grants Program Request for Proposals Application Guidelines The Coming of the Blessing

March of Dimes Nevada Community Grants Program. Request for Proposals (RFP) Guidelines. PROPOSAL DEADLINE EXTENDED: October 6, 2017

March of Dimes Nevada Community Grants Program. Request for Proposals Guidelines. PROPOSAL DEADLINE: December 2, 2016

March of Dimes Utah Community Grants Program. Request for Proposals Guidelines. PROPOSAL DEADLINE: March 24, 2017

STERILIZATION CONSENT FORM INSTRUCTIONS

RN-to-BSN PROGRAM APPLICATION

Performance Measurement in Maternal and Child Health. Recife, Brazil

2016 FASD prevention grants

Welcome Baby Prenatal Intake

Home Health Quality Improvement Campaign

SCHOOL OF NURSING POLICY

Service Transfer Information Form

NSCA Scholarship Application

CoIIN: Using the Science of Quality Improvement and Collaborative Learning to Reduce Infant Mortality

MESA Summer Academy: Solar System Mission Possible Application Deadline: June 1, 2018 Early Bird Discount Deadline: May 1, 2018

Infant Mortality Reduction Programs: Examples of Successful Models

MINNESOTA 2010 Needs Assessment

Zip Code/Postal Code

The completed application form and two recommendations must be postmarked or delivered by the application deadline, February 26, 2016.

Example Application DO NOT SUBMIT

CPRS Application. Certified Peer Recovery Specialist. VCB CPRS Application Revised February

How Do You Operationalize Health Equity? How Do We Tip The Scale?

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM YEAR 2016/17

Sponsorship Opportunities

HCAHPS Survey SURVEY INSTRUCTIONS

SUBJECT: Certificate Change Proposal Maternal and Child Health

Fogarty Global Health Fellowships NORTHERN/PACIFIC GLOBAL HEALTH RESEARCH FELLOWS TRAINING CONSORTIUM

Maternal, Child and Adolescent Health Report

2015 McKnight Artist Fellowships for Ceramic Artists

Young, Beginning, Small and Minority Farmer elearning Course Ag Biz Planner

APPLICATION FOR TESTING AND SUBSEQUENT CERTIFICATION AS A CERTIFIED NURSE-MIDWIFE (CNM)

2018 Scholarship Application

Thank you for your interest in employment with Black Hills Surgical Hospital and Black Hills Urgent Care.

Dear Kaniksu Patient,

Equity and Inclusion STEM Thought Leaders Summit and Advanced Technological Education (ATE) Conference Opportunity

PLEASE BE AWARE THAT YOU WILL NOT BE ABLE TO SAVE YOUR PROGRESS, SO PLEASE PREPARE ALL OF YOUR ANSWERS AND UPLOADABLE FILES IN ADVANCE.

DELTA STATE UNIVERSITY ROBERT E. SMITH SCHOOL OF NURSING RN TO BSN COMPLETION PROGRAM APPLICATION

DOL H1B-Gulf Coast Ready To Work Petrochem Grant

DOL H1B-Gulf Coast Ready To Work Petrochem Grant

Our Mission. March of Dimes NICU Family Support. March of Dimes: Champion for All Babies. NICU Family Support: Core Program Goals

3. Expand providers prescription capability to include alternatives such as cooking and physical activity classes.

ALIGNING STATE AND LOCAL HEALTH DEPARTMENTS TO IMPROVE MATERNAL AND CHILD HEALTH

Today s date: Social Security Number: Birth Date MM/DD/YY / / City State Zip Parish/County

REGISTRATION FORM (Minors)

EMPLOYMENT APPLICATION

APPENDIX B Consultant Title VI Evaluation Form

AMERICAN AMBULANCE SERVICE, INC.

FREE TRAINING CAREER SUPPORT SERVICES

Manhattan-Staten Island Area Health Education Center

2015 All-Campus Career Fair Student Survey

HELENE FULD COLLEGE OF NURSING

Leadership Commitment to Project GO goals Diversity For more information about Project GO, please visit

2015 DUPLIN COUNTY SOTCH REPORT

Application For Employment

Additionally, the parent or legal guardian must provide the following documents upon registration of a new student:

CCSNH/NASA SPACE GRANT Scholarships Inspiring Future Engineers and Scientists. For Students Pursuing STEM* Careers

APPLICATION FOR EMPLOYMENT

THE HUTTON JUNIOR FISHERIES BIOLOGY PROGRAM 2017 STUDENT APPLICATION Application Deadline: January 31, 2017

PLEASE BE AWARE THAT YOU WILL NOT BE ABLE TO SAVE YOUR PROGRESS, SO PLEASE PREPARE ALL OF YOUR ANSWERS AND UPLOADABLE FILES IN ADVANCE.

Equal Employment Opportunity Self-Identification Applicant Survey

Scholarship Application Due October 31, PM ET/5PM PT

Pediatric Integration of Behavioral Health Grant Opportunity 2015 Request for Proposal

2017 NCLEX-PN Test Plan Overview. Kristin Singer, MSN, RN RN Test Development Associate, Examinations

PLEASE FILL OUT FORM BELOW AND THEN FAX BACK TO: ADDITIONALLY, PLEASE BRING FORM WITH YOU ON THE DAY OF YOUR SCHEDULED APPOINTMENT.

How Supporting Breastfeeding Advances Health Equity

2017 COMMUNITY GRANTS PROGRAM

W e l c o m e t o B i l l e r i c a C h i r o p r a c t i c

APPLICATION FOR EMPLOYMENT

Centerstone s PSE HELP Program:

Equity, Health, and Community Connections

Healthy Eating Research 2018 Call for Proposals

Women in Aerospace Foundation, Inc.

NRPA/Walmart Foundation 2017 Healthy Out-of-School Time Grant Application

APPLICATION

APRIL HEALTHY START INITIATIVE

MINERAL COUNTY MONTANA. Community Health Assessment

NATIONAL GEOGRAPHIC SOCIETY CONSERVATION GRANT APPLICATION PREPARATION

FORM 1 MCHB PROJECT BUDGET DETAILS FOR FY

APPLICATION FOR EMPLOYMENT

College of Lake County Children s Learning Center Child Care Access Means Parents in School CCAMPIS Grant Application (Please print or type)

March 6, 2016 Cambridge, MA. Health Equity. Amy Reid, MPH

Commonwealth Fund Scorecard on State Health System Performance, Baseline

16 th Annual Nurse Camp Application Packet Checklist

Michigan Council for Maternal and Child Health 2018 Policy Agenda

Responsible Party Information (Information used for patient balance statements) Responsible Party Another Patient Guarantor Self

DELTA SIGMA THETA SORORITY, INC. CINCINNATI ALUMNAE CHAPTER SCHOLASTIC ACHIEVEMENT AWARD (TYPE or PRINT ALL Information with a Black Ballpoint Pen)

MAIN STREET RADIOLOGY

UCSD Staff Association Career Experience for High School Students June 23- August 15, 2014 (eight weeks)

HOMELESS VETERAN REGISTRY NORTHWEST MINNESOTA

Enhancing Diversity in the Wisconsin Nursing Workforce

AVI Systems, Inc. Employment Application

New Substitute Paraprofessional or Secretary Fingerprint-Based Criminal Background Check Procedures

- Cardiac Catherization - Cardiac Angioplasty - Cardiac Bypass - MUGA - CT Scan

HCAHPS Survey SURVEY INSTRUCTIONS

Transcription:

March of Dimes Washington State Community Grants Program March of Dimes Washington Kasey Rivas, MPH Maternal & Child Health Director 1904 Third Ave, Suite 230 Seattle, WA 98101 206-452-6631 krivas@marchofdimes.org 3

I. MARCH OF DIMES CHAPTER COMMUNITY GRANTS PROGRAM Founded in 1938, the mission of the March of Dimes is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. We do this by funding research to understand the problem and discover answers, helping moms have full-term pregnancies and healthy babies, and supporting families and comforting them when their baby needs help to survive and thrive. Premature birth is the leading cause of newborn death worldwide. Even babies born just a few weeks too soon can face serious health challenges and are at risk of lifelong disabilities. In 2003, the March of Dimes launched the Prematurity Campaign to address the crisis and help families have healthy, full-term babies. The campaign funds research to find the causes of premature birth, and to identify and test promising interventions; educates health care providers and women about risk-reduction strategies; advocates to expand access to health care coverage to improve maternity care and infant health outcomes; provides information and emotional support to families affected by prematurity; and generates concern and action around the problem. As part of this effort, the Washington Community Grants Program is designed to invest in priority projects that further the March of Dimes mission, support campaign objectives, and further our strategic goal of promoting equity in birth outcomes. II. AVAILABLE FUNDING AND 2015 FUNDING PRIORITY AREAS The applicant must provide services in Washington. Community awards are not to be used for program evaluation. The chapter s community awards fund for 2018 is approximately $3,300. Awards may be granted up to $3,000. For larger grants, contact the March of Dimes Washington to learn more about the March of Dimes Chapter Community Grants Program. Below are current primary and secondary categories in which March of Dimes provides community awards: Primary purpose category: Professional education and training Quality improvement Secondary purpose category: One Key Question implementation IMPLICIT interconception care implementation Risk reduction education/services (smoking cessation) o SCRIPT training, Baby and Me Tobacco Free III. ELIGIBILITY In order to be eligible to receive a March of Dimes chapter community award, an organization must be an incorporated not-for-profit 501(c)(3) or for profit organization or government agency. The March of Dimes does not award grants to individuals. Applicants must disclose any conflict of interest due to representation by their organization on the March of Dimes Washington Maternal & Child Health Programs Committee.

The March of Dimes does not fund billable health care provider services. The March of Dimes chapter community grants and awards also do not fund scientific research projects. For information about research grants funded by the March of Dimes national office, please go to marchofdimes.com/research.

All grantees must (i) certify that they are not presently listed on the Federal Excluded Party List, debarred or suspended from the award of any federal or state contracts, or excluded from participation in any governmental medical reimbursement programs; and must (ii) attest that they /will comply with all laws and regulations (to include federal, state and local laws and regulations). Additionally, March of Dimes grantees may be screened to ensure that they are not debarred or suspended by the Federal Government and/or local State agencies. IV. APPLICATION DEADLINES AND TEMPLATE Applications due: 09/01/17 @ 4pm Notification of awards: 01/08/18 Grant period: 01/15/18 12/31/18 Applicants must submit one original proposal (with original signatures in appropriate places) to the address below by the date listed above. Applicants should also send an electronic copy of the proposal to the address below by the date listed above. The electronic copy should be one complete file, either a PDF document (recommended) or a Microsoft Word document. Do NOT fax applications. Applications must be received by 4:00PM on 09/01/17. Late applications will not be accepted. Proposals should be sent to: Kasey Rivas MPH, MCH Director March of Dimes Washington 1904 Third Avenue, Suite 230 Seattle, WA 98101 krivas@marchofdimes.org 206-452-6631 4

March of Dimes Project Overview Applicant Organization: Address: City: State: Zip: Project Title: Contact Name : Phone: Fax: E-mail: Institution Type (choose one): [ ] Clinic [ ] Community-based Organization [ ] Educational Institution [ ] Health Department (State/Local) [ ] Hospital [ ] Other For-Profit Organization [ ] Professional Association [ ] Other Please provide a brief synopsis of your project (2 sentences are sufficient): Please list the one primary and one secondary purpose category that the application addresses (categories listed in Section II): Primary: Secondary: Updated: January 2014 Page 1

Approximately how many unduplicated individuals will be served during year one? Does this project target adolescents (17 and under)? [ ] Yes [ ] No Does this project aim to reduce disparities? [ ] Yes [ ] No Select the race/ethnicity of the majority of individuals expected to be served by this project (if applicable): RACE: [ ] White [ ] Black or African American [ ] American Indian or Alaska Native [ ] Asian [ ] Native Hawaiian or Other Pacific Islander [ ] Other ETHNICITY: [ ] Hispanic Total amount requested: $ If awarded, check should be made out to: / / Signature - Primary Staff Person Date Type Name and Title

Project Description What is the problem that this project will try to address? Why do we care about the problem? What gaps will the project fill? What activities will you undertake to achieve results? What changes/impact do you expect to occur as a result of the activities described above? Updated: January 2015 Page 3