THE COMMUNITY ACTION BOARD, INC. COMMUNITY INITIATIVES REQUEST FOR APPLICATION (RFA)

Transcription

1 THE COMMUNITY ACTION BOARD, INC. COMMUNITY INITIATIVES REQUEST FOR APPLICATION (RFA)

2 Community Action Board, Inc. Community Initiatives Request for Application (RFA) This community initiatives program request for application (RFA) announces an opportunity for individuals, community-based or faith-based organizations to apply for funding for community initiatives. This packet includes: community initiatives request for application, budget justification, evaluations and program sign-in sheet. ABOUT THE BOARD The Community Action Board, Inc. (or CAB") is a nonprofit organization that serves the greater Orangeburg community. The CAB is a 13-member action board comprised of key community leaders across various sectors of the county (nursing, education, social work, faith-based, and other community-based agencies). The CAB s primary interest is meeting the needs of individuals within the community while demonstrating the strength and viability of academic-community partnerships. The CAB is an existing community-based initiative under USC/Coordinating Center of Excellence in the Social Promotion of Health Equity through Research, Education, and Community Engagement (CCE-SPHERE), in partnership with the Minority AIDS Council of Orangeburg, Bamberg, and Calhoun Counties (MAC). The effort is funded by the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH). The CAB will be the lead entity in administration of the community initiatives program to support proposed activities. CAB will provide technical assistance to help recipients keep accurate records of how funds are spent. ELIGIBILITY CRITERIA CAB community initiatives will support communities by providing funds that will be used to initiate or develop programs that address issues in response to national efforts to eliminate racial disparities in health related areas. All RFA respondents must meet the following eligibility requirements. Submissions that fail to meet these criteria will not be considered and will be returned for non-compliance. Respondents must: a. Be a single non-profit organization, community-based organization or faith-based entity. b. Be able to document support of the Director/Governing Body representing the organization. c. Be able to demonstrate their ability to manage and report financial expenditures related to program activities. d. Serve the greater Orangeburg community or surrounding areas (Calhoun, Bamberg) PROPOSED ACTIVITIES RFA respondent(s) MUST propose a project or activities that focus on one or more of the following health-related areas: 1) HIV/AIDS, 2) HPV/cervical cancer, 3) environmental health, 4) chronic disease prevention or self-management, 5) community health education and promotion, 6) youth health initiatives, 7) physical activity, 8) healthy living or 9) other health-related topic. Respondent(s) must summarize their plan of action; which includes a brief 2

3 description of the groups with whom they will be working, a description of their plans to identify, recruit, or engage participants in their program, as well as description of the types of activities they intend to coordinate. Respondent must provide a brief description of strategies or measures they will use to prove they have met their objectives (e.g., pre-post knowledge test, participant satisfaction surveys, sign in sheets, workshop evaluations, etc.) FUNDS Budget may include honorariums, workshop facilitator fees, program expenses and other expenses pertinent to the successful accomplishment of your proposal. For example: light refreshments and beverages for workshops. To monitor oversight of fund distribution, CAB will review recipients budget request during the project period and at the end of the reporting period. If awarded funding, the Community Action Board, Inc. (CAB) and Coordinating Center of Excellence in the Social Promotion of Health Equity Through Research, Education, and Community Engagement (CCE-SPHERE) will need to be acknowledged by your program or activities events. The following statement will need to be noted in all written materials: Funding to support this community outreach and engagement project was made possible (in part) by P20MD from the National Institute on Minority Health and Health Disparities and is managed by the CCE- SPHERE and Community Action Board, Inc. Project activities, materials, views expressed in written materials, or publications and presentations delivered by speakers and moderators, do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government or CAB. APPLICATION INSTRUCTIONS ON SUBMISSION Applications may be submitted by , mail or express delivery services via the following address before the first Monday of every month: Community Action Board (CAB), Inc. Attn: Grant Committee P.O. Box 1092 Orangeburg, SC ICAB@mailbox.sc.edu or CLINTOKS@mailbox.sc.edu Applications may be hand-delivered to the following physical address: OR CCE-SPHERE/CEOC ATTN: Community Action Board, Inc. Karen Clinton, Senior Community Liaison 681 Broughton Street Orangeburg, SC Contact Person: Karen or Note: CAB is not responsible for delayed or lost mail. Any responses not meeting this criterion will be redirected back to the sender. 3

4 APPLICATION Organization: Address: City: State: Zip Code: Address: Phone Number (s): Fax: Contact Person (s): Signature: Date Submitted: 4

5 PROPOSAL PURPOSE/HISTORY: Describe your purpose for the program and past program (s) history, if available.) GOALS Example: KLM will educate the congregation about HIV/AIDS. MEASURABLE OBJECTIVES/ INTERVENTIONS KLM will educate 100 individuals on HIV/AIDS awareness, prevention and testing. A HIV/AIDS expert and PLWHA will conduct a panel discussion to educate congregation. ACHIEVEMENT DATE KLM will complete this activity on 12/1 PROGRAM PROPOSAL: (Describe your program) provide detail information about your program and goals. 5

6 BUDGET LINE ITEM JUSTIFICATION Honorarium Quantity Cost Per Total Cost Guest Facilitator (s) Guest Speaker (s) Total Program Expenses Quantity Cost Per Total Cost Educational Literature / Educational Display Materials: t-shirts, ribbons, Light refreshments Facility Total Printing Quantity Cost Per Total Cost Pictures Marketing Total Supplies Quantity Cost Per Total Cost Easels, flip charts and other presentation items Photo album (s) Office supplies Miscellaneous Quantity Cost Per Total Cost Total 6

7 BUDGET JUSTIFICATION: Justify the need for expenses. HONORARIUM: PROGRAM EXPENSES: PRINTING: SUPPLIES: MISCELLANEOUS: 7

8 PROGRAM END-REPORT This form must be completed and returned to the CAB, INC. 10 days after the event. Please write or type your answers in the white space. Organization: City and County: Name of Person Completing Report: Date of Submission: Section I: Main National HIV/AIDS Awareness Event / Main National HPV, Cervical Cancer Awareness Event / Main National Health Disparities Awareness Event. Please complete the following table with information about your main activity. Activity Name: Activity Date: Begin Time: End Time: 8

9 Number of men present: Number of women present: Number of children present: Describe the Activity: Did you partner with another organization for your activities? If so, please name the organization(s). 9

10 Organization Name of Program or Activity Date EVALUATION Evaluation of Presenter (s) please circle one 1. Presenter (s) knowledge of the subject matter Excellent Good Fair Poor N/A 2. Presenter (s) method of presentation Excellent Good Fair Poor N/A 3. Presenter (s) ability to answer questions Excellent Good Fair Poor N/A 4. Presenter (s) use of technology Excellent Good Fair Poor N/A 5. Overall evaluation of Presenter (s) Excellent Good Fair Poor N/A Evaluation of Workshop 1. Did this program meet or exceed or not meet your expectations? What interesting information did you learn during this program that you did not know prior to this program? What will you do with the new information learned as a result of this program? How did you learn about the event? Flyer Employer Friend/Associate Teacher/Professor Media Other 10

11 Organization Name of Program or Activity Sign In Date SIGN-IN SHEET MALE FEMALE AGE 11