2017-18Ohio State University Opioid Innovation Fund (OIF)

Pre-Proposal Template

TemplateInstructions

  • Review Call for Pre- Proposal complete application instructions.
  • Cover Page. Complete sections 1-5, not to exceed one page.
  • Narrative. Complete sections 6-11, not to exceed two pages. The length of individualNarrativesections may be adjusted. Rows can be added or deleted from tables.
  • Template Instructions and explanatory text, in italics followingNarrative section headers, may be deleted to make room for content.
  • Cover Page and Narrative must be in 11-point Calibri or Arial font, single-spaced, with 1-inch margins.
  • Cover Page andNarrative are due as a single PDF document (not to exceed 3 pages total)by 5 p.m., Friday, November 3, 2017. Please email all materials and any questions to

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COVER PAGE

  1. Pre-proposal/ProjectTitle:
  1. Single Point of Contact Information

Name: / Email
Title/Position / Phone
  1. Program Stage(Check the one that most closely applies to your program’s development stage.)

Planning / Implementation

4a. Geographic Focus(Check all that apply)

Ohio’s 88 Counties / Central Ohio / Other

4b. Type of Partnerships(Check all that apply)

Community org / Non-profit / Non-OSU University, College, and/orSchool
Local or state gov’t / Business/Industry / Local resources (such as libraries)
RegionalCampus / Extension / Other

5. Executive Summary (250-word limit)

Citations (if any)

NARRATIVE

6. Statement of Challenge/Opportunity. Provide clear evidence to document the challenge or opportunity.

7. Approach.Describe the target population and state howthe proposed work will address the challenge/opportunity.

8. Outcomes and Evaluation. Clearly describe expectedoutcomes and where possible community impacts and specifically identify how they will be measured and evaluated.

9. Sustainability. Describe vision and/or growth plan for long-term viability of the program beyond the OIF grantsupport.

10. Team Members and Qualifications. Identify up to five team members, including internal to OSU and external members.

11. Budget and Justification. Estimate the level of funding requested for the OIF grant together with budget justification. Include cost share and additional sources of funding.Also identify any expected budgetary overlap in OIF grant with existing or pending funding.

Source / Grant ($) / Cost Share ($)
1)Grant Fund Request (OIF grant):
2)Source of Cost Share (if any):

Budget Justification:

Other Sources of Opioid-Related Funding (Title and Source) / Grant ($) / Overlap (Y/N)

Description of Overlap: