week 6

Targeted Application (2017-2018 Fall)

Community Health Endowment of Lincoln Nebraska

Grant Number

Grant Number

Character Limit: 100

Project Name*

Character Limit: 100

Project Summary*

Character Limit: 350

Total Request from CHE*

Character Limit: 20

Amount Requested Year 1*

Character Limit: 20

Amount Requested Year 2*

Amount Requested Year 3*

Character Limit: 20

Character Limit: 20

Total Project Cost*

Character Limit: 20

FUNDING PRIORITIES

Health Innovation

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 Trauma

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

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

Health Innovation

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 Trauma

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

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

Population(s) to be Served Provide a clear description of the population(s) that will be served by your project. Why did you

choose to focus on this population? What are the size, characteristics and location of the

population? How many people and what percentage of the target population will be served by

your project? 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) to

support your focus on this target population. Maps, both static and interactive, from CHE’s

Place Matters Community Mapping project are available here:

http://www.chelincoln.org/placematters/.

Character Limit: 4000

Project Outcomes Describe specific and measurable outcomes you expect to achieve. Describe the indicators you

will track to measure your progress toward these outcomes and how you will evaluate the

project. Be ambitious, yet reasonable, in proposing outcomes. Whenever possible, set your

project outcomes relative to baseline data.

Character Limit: 4000

Project Overview and Activities Describe your project and the activities you will undertake to achieve your expected outcomes.

Identify any partnerships or collaborations that will be part of the project and the current status

of those relationships.

Character Limit: 10000

Expected Barriers/Challenges Every project will face barriers and challenges. Describe barriers and challenges that could arise

for your project and how you would address them.

Character Limit: 4000

Diverse Perspectives How do you propose to draw upon diverse perspectives in the community to strengthen the

proposed project?

Character Limit: 2400

Applicant's Qualifications Describe how your organization is uniquely qualified to carry out this project. If you include

information about your organization’s history, mission, vision, services provided, and/or

populations and geographic area served, explain how it is relevant to your ability to successfully

complete this project.

Character Limit: 2400

Applicant Status SKIP

Has your agency violated state or federal law in the current year or the preceding two years?

No

BUDGET AND JUSTIFICATION

Budget Justification Submit revisions from Week 4.

Sustainability If this project is funded, describe how/if you will continue the project when CHE funding ends.

What is it about this project that is likely to attract ongoing interest and support?

Character Limit: 2400

Rationale Why is your project the best use of CHE funds?

Character Limit: 1200

Board of Directors Roster SKIP

Operating Budget SKIP

The agency's operating budget for the current year. File Size Limit: 3 MB

Income/Expense Statement SKIP

The agency's income/expense statement and balance sheet for the current period. Choices Not Applicable/Not Available File Size Limit: 4 MB

Financial Statements SKIP

Provide the highest level financial statement review available for the most recent complete fiscal year, unless a government agency. (If your statements are not audited or reviewed, submit a balance sheet and income/expense statement for your agency's most recently completed fiscal year.) Choices Not Applicable/Not Available File Size Limit: 4 MB

ELECTRONIC SIGNATURES SKIP

Authorized Officer Signature SKIP

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

References include this