PSY-8118v2GrantWritinginPsychology4339295766-1022022-1110AM.zip

CHE 2017-2018 Applicant Information3.pdf

               

2017‐18  Applicant Information 

April 2017 

   

2017‐18 CHE Applicant Information    2 

 

Notes   

2017‐18 CHE Applicant Information    3 

 

These guidelines describe the Community Health Endowment of Lincoln’s funding priorities and  preferences for the Fall 2017 and Spring 2018 grant cycles and provide additional information to help  organizations successfully complete a CHE grant application.    In 2015, the Community Health Endowment (CHE), in collaboration with the Lincoln‐Lancaster County  Health Department, City of Lincoln Urban Development Department and NeighborWorks Lincoln,  released Place Matters, a community mapping project undertaken to better understand the role of  “place” in health status and behaviors. This information yielded startling, yet valuable, information and  greatly influenced CHE’s funding priorities.     Informed by that work and the “Time to Act:  Investing in the Health of Our Children and Communities”  report by the Robert Wood Johnson Foundation Commission to Build a Healthier America, CHE believes  that the hope of a healthier community lies in “health beyond health care.”  Therefore, the CHE Board of  Trustees established the following Funding Priorities and Preferences:   

Funding Priorities and Preferences  Affirmed March 2017   

Priorities  CHE has three funding priority areas for 2017‐18. 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  • Helping adults and children stay healthy outside of a clinical setting  • Embracing bold ideas and community‐based solutions that enhance traditional models of health 

care and/or behavioral health care    Early Childhood Investments  • Reducing or eliminating childhood toxic stress  • Reducing childhood obesity  • Improving maternal health and birth outcomes    Prevention  • Fostering healthy behaviors that lead to improved health outcomes 

 

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  • The application creates intentional linkages between cross‐sector partners in areas such as health, 

housing, neighborhoods, finance/banking, economic development, education, and others.   

Impact on Poverty  • The application recognizes the role poverty plays in causing or addressing a community issue. 

2017‐18 CHE Applicant Information    4 

 

  Use of Local Data  • The application uses local data to inform the need, target group, or geographic area to be 

addressed.    Evidence‐Based Models  • The application uses evidence‐based models or proven approaches to inform program design and 

delivery. 

  Funding Calendars 2017‐2018   

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 

   

Spring 2018 Grant Cycle   

Week of October 16, 2017  Applicant Workshops (Tentative ‐ Check website for updates.) 

January 12, 2018, 12 noon  Stage I Applications Due 

By February 23, 2018  Invitations Extended to Submit Stage II Applications 

March 30, 2018, 12 noon  Stage II Applications Due 

May 25, 2017  Grantees Notified 

July 1, 2017  Grant Period Begins – Funds Available 

   

Funding Categories   

Targeted   Must address one or more funding priorities 

 Requests for matching funds for capital construction, facility renovation, and equipment are  eligible 

 Up to 3 years of support 

 Any amount   

Spark!   Must address one or more funding priorities 

 Ignite, test, take a risk, innovate, transform 

 One‐time, one‐year, non‐renewable 

 Up to $20,000 

2017‐18 CHE Applicant Information    5 

 

   

Eligible to Apply   501(c)3 organizations 

 Government and public agencies 

 Dollar‐for‐dollar matching funds for capital projects   

Not Eligible to Apply   Individuals through direct financial contributions 

 Projects outside Lincoln and surrounding area 

 Laboratory or clinical research 

 Non tax‐exempt organizations 

 Endowments 

 Fundraising efforts 

 Lobbying 

 Debt reduction     

Application Process  CHE uses an online application for all applications. The application form is accessible on the CHE website  here:  http://www.chelincoln.org/grant_program/ready_to_apply.html. CHE recommends that you  compose your 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  the application after you paste the information into the online form.    CHE uses a two‐stage application process. Stage I (LOI) is a short application that will give CHE a good  understanding of the proposed project and the difference you hope to make through the project  without requiring a full application. Stage II is open to invited applicants only and requires a full  application, work plan, detailed budget and supporting documents.     

2017‐18 CHE Applicant Information    6 

 

Six Big Ideas for Grant Writing Success  by Kim Hachiya 

 

1. Read all the directions.  a. Ask questions if you don’t understand or need more information  b. Look for key phrases, etc., that the grantor is highlighting. 

2. Collect all the data the grantmaker requests; learn how to do research using the internet and  other research techniques. Use keywords, phrases, and follow suggested links. The good people  at the public library can be very helpful.  

3. Answer the questions that are asked.   4. Draw bright and solid connections between your agency and the items the grantmaker requests. 

No need to be subtle. Be positive, active, and affirmative.  5. Write in active voice; edit ruthlessly; remember that spelling and grammar matter. Mistakes 

indicate sloppy thinking or that you really didn’t care enough to sweat the details. It can push an  “on the bubble” applicant into the “no” category. 

6. Meet the deadlines. Noon does not mean 12:01. Grantmaker looking for ways to eliminate  applications and see late applicants as low‐hanging fruit. And it’s an issue of fairness. If everyone  else played by the rules, so should you. 

 

 

Six More Ideas  1. Talk through your application out loud with another person; write down the ideas. Then use 

those as the outline for writing.  2. When citing sources from the web, convert long URLs into short URLs with either tinyurl.com or 

bitly.com.   3. Avoid your industry’s jargon.  4. Have someone less familiar with your agency read your drafts to spot holes or inconsistencies 

that you missed due to your insider knowledge.   5. Have someone else proofread your document to catch spelling, grammar, etc. Do not rely solely 

on spellcheck/grammar check for this.   6. To save characters when doing an application that is character limited, use just one space after a 

period. (That’s actually how you should be doing it if you use a computer but a lot of people  persist in doing it the old‐fashioned way.) Delete words like very or really. Use numerals instead  of spelling out numbers.  

 

 

Contact Information: 

Kim Hachiya 

[email protected] 

(402) 421‐9588 (preferred) 

(402) 570‐9931 (alternate) 

   

2017‐18 CHE Applicant Information    7 

 

Application Questions  The following questions are included in each stage of the CHE application process. The number in  parentheses is the number of characters allowed for each answer.   

Stage I (LOI)   

 Project Name* (100)   

 Project Summary* (350)   

 Total Request from CHE* (20)  For Targeted Applications Only: 

 Amount Requested Year 1* 

 Amount Requested Year 2* 

 Amount Requested Year 3*   

 Total Project Cost* (20)   

 Funding Priority* (Select all that apply)   

 Project Description (2500) – Clearly describe how your project addresses one or more of the funding  priorities and why you believe this is the best or most innovative approach. Be sure you know your  target population. Include Lincoln‐specific data (demographics, health status, poverty rate) and, if  applicable, geographic target area (census tracts(s), block groups(s), neighborhood(s)).   

 Healthier Community & Outcomes (1500) – How will Lincoln be healthier if this project is funded?  How will you monitor, measure, and evaluate the outcomes of the project and the impact on the  target population?    

 Partnerships and Sustainability (1500) – 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.   

 Budget Explanation (500) – Explain any discrepancy between the Revenue and Expense budgets. Are  there other budget details that need further explanation?   

 Preliminary Budget (Excel template downloadable from online application)   

 

   

2017‐18 CHE Applicant Information    8 

 

Best Practices for Healthy Living Grant Applications  If you are seeking funding for wellness and fitness programs, you must address the following best  practices in your application. Use the narrative portions of the grant application and, in Stage II, the  work plan to describe how the proposed program and your organization will incorporate these practices. 

 

 Connection to Participant Priorities  o How does the project relate to the current life situation of the proposed participants? 

How have you measured the interest of proposed participants? 

 Plan to Attract Participants  o How will you attract or encourage individuals to participate? 

 Sense of Community Among Participants  o How will the participants develop a sense of community and accountability with one 

another and the project leaders? 

 Behavior Change  o What elements in the project will go beyond exposure and education and support long‐

term change in habits and behaviors? 

 Objective Assessment of Real Health Outcomes  o How will participants be assessed before, during and after the project? 

 Focus on Long‐Term Results  o Describe how this healthy living project fits with other programs and services offered by 

your organization. 

 Demonstrated Commitment to the Wellness of Your Organization’s Staff  o What healthy living or wellness programs and services does your organization currently 

offer to staff? 

 Demonstrated Commitment to Wellness Programming by Organizational Leadership  o The signature of your organization’s leader on the application verifies that your 

President, CEO, or Executive Director and Board are committed to healthy living  programs and services. 

 

   

2017‐18 CHE Applicant Information    9 

 

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     

   

2017‐18 CHE Applicant Information    10 

 

Budget Forms    CHE’s budget forms allow you to clearly identify sources of support and revenue. Support/Revenue and  Expenses are on separate tabs 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. The Stage I  application requires a less detailed budget than the Stage II application. Make sure to download the  appropriate template from the online application form. Samples of the budget forms follow this section.           

2017‐18 CHE Applicant Information    11 

 

   Agency Name:

Project Name:

SUPPORT/ REVENUE Total Support/Revenue

$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)

Project-Related Income/Revenue

Other Support

(Identify source(s) on separate lines below)

Cash Anticipated from Other Sources

Project-Related In-Kind Support

-

-

Cash Committed from Other Sources (Identify source(s) on separate lines below)

Year One Budget Stage I

Amount requested from CHE

(Identify source(s) on separate lines below)

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

2017‐18 CHE Applicant Information    12 

 

    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 $0 $0

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

Indirect Costs $0 $0

$0 $0

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

Equipment

supplies/equipment, printing, mileage)

Subtotal Personnel

Facility Improvement

Indirect (Not to exceed 10% of request from CHE)

Requested from CHE

(Equipment, technology)

Facility (Rent/Utilities)

(Professional development, travel,

(Telephone, postage, office

Operating Office Operations

Construction

Other (Identify)

DIFFERENCE

TOTAL SUPPORT/REVENUE

Total Expenses

(TOTAL EXPENSES)

DIFFERENCE

Subtotal Operating

Stage I

educational materials)

Medical Supplies

Facility-Related Equipment

Professional Services (Architect, etc.)

-

-

Salaries (list positions and FTE)

Payroll Taxes/Benefits (specify)

Training & Education

FTE

Personnel

2017‐18 CHE Applicant Information    13 

 

Frequently Asked Budget Questions 

Here are answers to some frequently asked budget questions:    Do you want to see the total project cost or just the funding we are requesting from CHE?  The application and budget forms provide places for you to show both the total project cost and the  funding you are requesting from CHE. Please include both.    Should we count in‐kind contributions in the total project cost?  Yes. Include equipment, supplies, staffing, rent, volunteers or other non‐monetary support that is a  direct benefit to the project. In‐kind contributions can be provided by the applicant or project partners.  In‐kind contributions cover costs that are necessary for the project to happen.     How do we show in‐kind contributions?  The budget templates for both Stage I and II applications include a column for in‐kind contributions. In  Stage II, if resources – in‐kind or otherwise – are being provided by project partners, make sure you  include a letter of commitment from the partner organization(s).    Does CHE fund operating costs?  Yes.    Does CHE fund indirect costs?  Yes. CHE considers indirect costs to be costs associated with administrative overhead, fiscal/accounting  services, and other general, operational and agency support that are not readily assignable to a specific  project or program. The amount you request for indirect costs should not exceed 10% of your total  request from CHE.    Does CHE require matching funds?  CHE requires a match only for capital, renovation or equipment grants. A match is not required for  Spark! grants. Cash or donated goods or services contributed by a third party count as matching funds.  General operating funds or in‐kind contributions by the applicant do NOT count as matching funds.  Donated goods and services received prior to the grant period may be considered match if the goods  and services are fully dedicated to the project.   

   

2017‐18 CHE Applicant Information    14 

 

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     

 

 

CHE Applicant Information Handout Aug20174.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 (Identify) 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 (specify)

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

CHE Stage 1 Targeted Application 20174.pdf

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.

CHE Stage 2 Targeted Application 20174.pdf

Application 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 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* Character Limit: 20

Amount Requested Year 3* Character Limit: 20

Total Project Cost* Character Limit: 20

Targeted Application Stage II (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 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.

Application Community Health Endowment of Lincoln Nebraska

Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 2

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 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.

Application 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 using the headings provided. Answer each question or statement included in the heading. Your response is limited to the character counts listed under each heading. Please note that character limits include spaces. CHE recommends that applicants compose your application in a word processing document, then copy and paste into the online application. Character counts can vary between programs. You may need to edit after you paste the information into the online application.

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

Application Community Health Endowment of Lincoln Nebraska

Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 4

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* Has your agency violated state or federal law in the current year or the preceding two years? Choices No Yes

Explanation If yes, please explain. Character Limit: 1000

WORK PLAN

Project Work Plan* Please complete the following steps to attach your work plan. Refer to the work plan worksheet to guidance in completing your work plan.

1. Download the work plan template. 2. Complete the work plan and save it to your computer. Be sure to fill in the " Project

Name" and "Agency" sections of the form. 3. Attach the completed work plan to this application by clicking the Upload a file button

below. File Size Limit: 1 MB

BUDGET AND JUSTIFICATION

Budget* https://chelincolnorg.presencehost.net/file_download/d143af7b-b936-4161-aad1- 8881dc1e7362A Budget is required for each year of requested funding. The Budget template available in Excel format. Two tabs are provided for each budget year in this file (one tab for support/revenue and one tab for expenses). Please complete the following steps to submit your Budget Form(s).

Application Community Health Endowment of Lincoln Nebraska

Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 5

 Download a Budget template.

 Complete the Budget and save it to your computer.

 Attach the completed Budget to this application by clicking the Upload a file button below.

File Size Limit: 1 MB

Budget Justification Explain any discrepancy between the Revenue and Expense budgets. Explain the factors used to determine the costs of budget line items such as mileage rates, personnel benefits, etc., and any other factors affecting your budget. Character Limit: 1000

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

SUPPORTING DOCUMENTS Please upload documents in PDF format whenever possible. If the document is not available in a digital format, you can use the “Fax to File” option available in the Tools section.

Board of Directors Roster* Attach a roster of the agency’s Board of Directors or governing body including individual names, affiliations, and addresses, and an aggregate summary of the race/ethnicity and gender composition of the Board. The summary is required. File Size Limit: 1 MB

Letters of Commitment

Attach no more than three (3) letters of commitment. A letter of commitment provides evidence of sharing of actual resources. Include only letters that show a commitment of financial or human resources to the project. If you have included other sources of support in your Revenue Budget, either cash or in-kind, that support should be documented with a Letter of Commitment.

Application Community Health Endowment of Lincoln Nebraska

Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 6

Letter #1 File Size Limit: 1 MB

Letter #2 File Size Limit: 1 MB

Letter #3 File Size Limit: 1 MB

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

Income/Expense Statement 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 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

Authorized Officer Signature* Enter your full name, business title, and the date of submission. (e.g.; Erin Smith, Executive Director, August 20, 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.

Application Community Health Endowment of Lincoln Nebraska

Printed On: 29 August 2017 Targeted Application (2017-2018 Fall) 7

Choices I Agree

NOTE: Your submission of this application completes the application process. There is no need to provide additional hard copies of these materials to CHE.