CHEApplicantInformationHandoutAug20171.pdf

Fall 2017 – Stage II Applicant Information

August 2017

Fall 2017 – Stage II CHE Applicant Information 2

Notes

Fall 2017 – Stage II CHE Applicant Information 3

What You Need to Know and Collect Before You Start Writing • Stage I questions (if you got any) and your responses

• Letter of invitation to Stage II

• Commitments from partners and supporters

• What success looks like

• How you will monitor progress and measure success

• Local data and/or maps to support application

Places to Look for Data • CHE’s Place Matters project: www.chelincoln.org/placematters • City of Lincoln Open Data and Performance Management portal: www.opendata.lincoln.ne.gov

o Lincoln-Lancaster County Health Department, Health Promotion, Data, and Evaluation: http://lincoln.ne.gov/city/health/pde/

• Lincoln Vital Signs: lincolnvitalsigns.org • Lincoln Public Schools: lps.org DepartmentsInstructionAssessment & Evaluation • Nebraska Department of Education: drs.education.ne.gov • Nebraska Department of Health & Human Services: dhhs.ne.gov

Fall 2017 – Stage II CHE Applicant Information 4

Stage II Application Questions

(Separate handout)

Fall 2017 – Stage II CHE Applicant Information 5

(insert work plan template here)

Fall 2017 – Stage II CHE Applicant Information 6

(insert work plan work sheet here)

Fall 2017 – Stage II CHE Applicant Information 7

Budget Forms CHE’s budget forms allow you to clearly identify sources of support and revenue. Just as in Stage I, the Support/Revenue budget is on a separate tab from the Expense budget on the budget form you will download from the online application. Please be sure to complete both tabs for each year of funding included in your application.

Fall 2017 – Stage II CHE Applicant Information 8

Agency Name:

Project Name:

Stage II Year One Budget SUPPORT/ REVENUE Total

Support/Revenue

$0

$0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0

$0 $0 $0

$0 $0 $0

$0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0

Total Support/Revenue $0 Click on Expenses Tab to complete your proposed budget.

(Identify source(s) on separate lines below)

(Identify source(s) on separate lines below)

Cash Committed from Other Sources

(Identify source(s) on separate lines below)

Project-Related Income/Revenue

Other Support

Project-Related In-Kind Support

CHE Grant Request

Cash Anticipated from Other Sources

(Identify source(s) on separate lines below)

(Identify source(s) on separate lines below)

The Support/Revenue budget form is the same for Stage I and Stage II.

Fill in the Agency Name & Project Name on the Year One Budget for Support/ Revenue and it will autofill on the subsequent tabs.

Fall 2017 – Stage II CHE Applicant Information 9

Agency Name: Project Name:

Year One Budget EXPENSES Total

Expenses

$0 $0 $0 $0

$0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 $0 Professional Development $0 $0 Travel $0 $0

$0 $0

$0 $0

$0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

Subtotal Expenses* $0 $0

$0 $0

$0 $0

$0 $0 $0 $0 $0 $0DIFFERENCE

Explain difference in the Budget Justification.

Indirect (Not to exceed 10% of subtotal expenses requested from CHE)*

Total Expenses

DIFFERENCE TOTAL SUPPORT/REVENUE (TOTAL EXPENSES)

Other (Identif y) Subtotal Operating

Rent Utilities

Facility Improvement Construction Facility-Related Equipment Professional Services (Architect, etc.)

Stage II

FTE Requested from CHE

Personnel Salaries (list postions and FTE)

Payroll Taxes/Benefits (specif y)

Subtotal Personnel Operating Office Operations

Telephone Postage Office Supplies/Equipment

Equipment Grant-Related Equipment

Grant-Related Technology

Facility

Printing Mileage

Training & Education

Educational Materials

Medical Supplies

The Stage II Expenses budget form asks for more detail than Stage I.

Fall 2017 – Stage II CHE Applicant Information 10

Fall 2017 Grant Cycle

Week of April 3, 2017 Applicant Workshop, CHE, 250 North 21st St. June 2, 2017, 12 noon Stage I Applications Due By July 21, 2017 Invitations Extended to Submit Stage II Applications September 1, 2017 12 noon Stage II Applications Due By October 27, 2017 Grantees Notified January 1, 2018 Grant Period Begins – Funds Available

We’re Here to Help! CHE staff want to answer questions about the funding priorities and preferences and the application process. Additional information is also available on the CHE website, www.chelincoln.org.

CHE Staff Lori Seibel, President/CEO [email protected]

Marcia White, Program Manager

[email protected]

Jodi Loos, Office Manager [email protected]

Contact Us

Community Health Endowment 250 No. 21st Street, Suite 2

Lincoln, NE 68503 P: 402-436-5516 F: 402-436-4128

www.chelincoln.org www.facebook.com/chelincoln

@che_lincoln