Week 3
LOI Community Health Endowment of Lincoln Nebraska
Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 1
Targeted Application (2017-2018 Fall) Community Health Endowment of Lincoln Nebraska Project Name* Character Limit: 100
Grant Number Grant Number Character Limit: 100
Project Summary Character Limit: 350
Total Requested from CHE* Character Limit: 20
Amount Requested Year 1* Character Limit: 20
Amount Requested Year 2* Character Limit: 20
Amount Requested Year 3* Character Limit: 20
Total Project Cost* Character Limit: 20
Targeted Application Stage I (2017-2018 Fall) Applications are limited to those that address one or more of the following priorities. Be sure to review more information about the funding priorities here. Select all funding priorities that apply to your project. Please note, that you cannot uncheck boxes.
FUNDING PRIORITIES CHE has three funding priority areas for 2017-2018. By inviting applications that address these priorities, CHE strives to tackle recognized community challenges, create lasting impact, and make Lincoln the healthiest community in the nation.
Health Innovation
LOI Community Health Endowment of Lincoln Nebraska
Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 2
Choices Helping adults and children stay healthy outside of a clinical setting Embracing bold ideas/solutions to enhance traditional models of health care/behavioral health
Early Childhood Investments Choices Reducing or eliminating childhood toxic stress Reducing childhood obesity Improving maternal health and birth outcomes
Prevention Choices Fostering healthy behaviors that lead to improved health outcomes
FUNDING PREFERENCES CHE believes that grant requests in the three priority areas can have an improved chance of success when certain factors are also considered. While including these factors in a grant application does not guarantee funding from CHE, applicants are encouraged to consider the following Funding Preferences whenever possible:
Cross-Sector Collaboration Choices Creates intentional linkages between cross-sector partners
Impact of Poverty Choices Recognizes the role poverty plays in causing or addressing a community issue
Use of Local Data Choices Uses local data to inform the need, target group or geographic area to be addressed
Evidence-Based Models Choices Uses evidence-based models or proven approaches to inform program design and delivery
If you are applying for a grant for fitness or wellness activities, please review this best practices document and include information in the narrative of your application about how you will address or incorporate these practices.
LOI Community Health Endowment of Lincoln Nebraska
Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 3
INSTRUCTIONS In the fields below, please provide a clear and concise summary of the proposed project. Your response is limited to the space provided. Please note that character limits include spaces. CHE recommends that applicants compose their application in a word processing document and copy and paste into the online application. Please be aware that character counts can vary between programs. You may need to edit after you paste the information into the online application.
Project Description Clearly describe how your project addresses one or more of the priorities and why you believe this is the best or most innovative approach.
Be sure you know your target population. Include Lincoln-specific data (e.g. demographics, health status, poverty rate) and, if applicable geographic target area (e.g. census tract(s), block group(s), neighborhood). Character Limit: 2500
Healthier Community* How will Lincoln be a healthier community if this project is funded? How will you monitor, measure and evaluate the outcomes of this project and the impact on the target population? Character Limit: 1500
Partnerships, Outcomes & Sustainability* What other groups or organizations will be involved in the project? If the project is funded, describe how you will continue the project when CHE funding ends. Character Limit: 1500
STAGE I BUDGET* A Stage I Budget is required for each year of requested funding. The Budget Forms are available in Excel format. Please complete the following steps to submit your budget.
Download a Budget template. Budget forms for Years 1, 2, and 3 are provided under separate tabs in the same Excel document. Please note, there are two tabs for each year.
Complete the Budget and save it to your computer.
Attach the completed Budget(s) to this application by clicking the Upload a file button below.
Additional budget detail will be required during the Stage II application process. File Size Limit: 2 MB
LOI Community Health Endowment of Lincoln Nebraska
Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 4
Budget Explanation Explain any discrepancy between the Revenue and Expense budgets. Are there other budget details that need further explanation? Character Limit: 500
Authorized Officer Signature* Enter full name, business title, and date of submission. (e.g.; Erin Smith, Executive Director, January 12, 2017) Character Limit: 100
By entering your signature and clicking "I Agree" you certify that the statements contained in this application are true and correct to the best of your knowledge and belief, and you are authorized to sign official documents on behalf of the organization.
Choices I Agree
NOTE: Your submission completes the application process. There is no need to provide additional hard copies of these materials to CHE.