2018 1-Year Healthy Community Grant Application
Deadline: November 27, 2017 /
Programs can apply for1-yearHealthy Community Grant funding to work towards criteria 4 and/or criteria 5 of the Healthy Community Recognition Program:
(1) Partnerships for Follow up Care
(2) Partnerships for Wellness Opportunities
The grant implementation period will be 1 April 2018 to 31 March 2019.
Special Olympics Programs are encouraged to replicate practices that match the strengths of their Program and correspond with the health needs of their athletes. Toolkits and resources can be found here:To achieve Healthy Community recognition, all the criteria listed below must be met and reported on annually. Criteria 1 and 2 are to be achieved Program-wide. Criteria 3, 4, 5 and 6 are to be achieved within the selected geographic area(s). To maintain Healthy Community Recognition status, SO Programs will need to report on these criteria annually (15 April or 15 October).
SO Programs are encouraged to focus their work in geographic area(s) within their SO Program and then apply learnings and successes to additional geographic areas. The minimum requirement for a SO Program to receive Healthy Communities Recognition is one geographic area. As the Healthy Communities work within an SO Program grows into new geographic areas, SO Programs will be required to include those areas in their Healthy Community reports.
Criteria / Details
1 / All health grant requirements met. / This includes former and ongoing Fitness, Family Health Forum, Healthy Athletes, and Healthy Communities grants. For Healthy Athlete events that received grant funding, all Healthy Athletes screening forms need to be entered into HAS within 30 days of the event date.
Note: This is also part of the eligibility to apply for a Healthy Communities Grant.
2 / SO Program locally funds at least 50% of Healthy Athletes event costs across all Healthy Athletes® events within the SO Program. / To meet the criteria, no more than 50% of the costs of running SO Program-wide Healthy Athletes events can be supported by Special Olympics International grants. At least 50% of SO Program-wide Healthy Athletes event costs need to be covered by local grants/sponsorship or value-in-kind (VIK) donations of goods and services such as rental space, equipment, giveaways, supplies and materials (not including VIK of volunteer time or SO Program staff time).
3 / SO Program offers at least three Healthy Athletes® disciplines per year within the selected Healthy Community geographic area(s) / Requires at least 3 different disciplines to be implemented at least once per calendar year resulting in a minimum of 150 athlete examinations within the geographic area(s) that the Healthy Community project is focusing to qualify for Healthy Communities.
4 / 70% of athletes who receive referrals at Healthy Athletes® within the selected Healthy Community geographic area(s) have a place to go for follow-up care following a Healthy Athletes examination. / Criteria must be met for at least two disciplines per calendar year. For athletes that are given a referral (as indicated on the HAS form), they either indicate they already have an existing doctor/dentist that they will book an appointment with or the SO Program connects the athlete to a specific health care provider, partner, or place to go to receive the care they need.
Note: Special Olympics wants to ensure as many athletes receive care as possible. SO Programs are to establish partnerships to ensure that their athletes have a place to go to receive care for their referrals.
5 / SO Program offers health, wellness or fitness programming outside of Healthy Athletes events for athletes involving partners, coaches and/or families as appropriate with a minimum of 20% of athletes in the SO Program’s selected geographic focus area enrolled in an ongoing wellness program. / Health, wellness or fitness programming is defined as reoccurring health education and/or engagement to improve health or prevent illness. To qualify, athletes must participate in 6 sessions minimum. For example, this could be nutrition lessons at 6 practices, 6 HIV awareness classes or a 6 week weight management program.
Note: The health, wellness or fitness programming may occur as part of a sports practice, but it must be an ongoing health activity that is beyond just sports training or sports skills development. These can be organized by the SO Program or through a partner. The ultimate goal is that one day all athletes are engaged in ongoing wellness opportunities and healthy activities!
6 / Sufficient sustainable resources to achieve the above criteria and deliver the project. / Available staff and resources (including partners) necessary to achieve the criteria going forward.
Note: If an SO Program is receiving a Healthy Communities grant, they need to be able to indicate how their work will be sustainable after the funding from SOI concludes.
- History of grant reporting compliance with no outstanding reports due.
- Previous success in implementing health programming including at least one of the following:
A.Health is seen as a strategic priority of the Program as evidenced by integration into operations and strategic plan.
B.Development of sustainable partnerships supporting Healthy Athletes events, wellness opportunities and/or follow up care.
C.Incorporation of Healthy Community approach (demonstrated progress towards meeting the Healthy Community criteria such as year round fitness or nutrition programs, connecting athletes to follow-up care afterHealthy Athletes, health classes/workshops, Family Health Forums, etc.)
- Submission of a grant proposalwhich outlines:
- Participation in technical assistance webinars and conference calls with SOI as needed.
- Completion of an end of project evaluation report including results from data collection throughout project duration and receipts documenting all expenses.
Special Olympics Programs may apply for up to $20,000 USDin award funds. Programs will be solely responsible for any expenditures in excess of the award. The award monies will be disbursed in one payment, in US dollars (USD) only.(Use for currency conversions.) Any unspent funds must be returned to Special Olympics International at the end of the award reporting period.Note: to maximize the grant funding available, not all Programs will receive the full amount.
Deadlines and Key Dates*
- November 27: Applications and budgets submitted to Regional Health Managers
- December 18: Selected Programs notified by SOI (award letters will be sent January-February)
- April 1: Earliest date that funds will be transferred to successful Programs
*Award letters and funding cannot be issued if there are any outstanding reports or the Program is not accredited
Contact Information at SOI
Director, Global Community Health Programs
Phone: (202) 824-0370
Once completed and signed by the CEO/President or National Director and Regional Managing Director, the application should be sent to your Regional Health Manager. It will be forwarded to SOI for review. If approved, SOI will send an award letter and contract to the program which must be signed and returned. Once the signed contract has been received, the payment will be sent.
SOI reserves the right to reject any and/or all applications.
Please submit your completed Healthy Communities Application to your Regional Health Manager:
Regional Health Manager Contacts):
- Special Olympics Africa: Maria Muller,
- Special Olympics Asia Pacific: Avi Tania,
- Special Olympics East Asia: Jason Zhan,
- Special Olympics Europe Eurasia: Bjoern Koehler,
- Special Olympics Latin America: Gonzalo Larrabure,
- Special Olympics Middle East/North Africa:
- Special Olympics North America: Heather Harmer
Grant Proposal Applications must be completed by SO Programs and include ALL of the following:
B.Objective and Overview
C.Timeline for planning, activation and evaluation of grant. (1 April 2018 – 31 March 2019)
D.Proposed detailed budget
E.Evaluation plan. This includes how you plan to track the success of the grant.
- Program Information
Special Olympics Program
Program Contact Name
Program Board Chair
Executive or National Director
Regional Managing Director
DUNS#(US Programs only)
*A DUNS Number is a 9 digit number for the physical location of your business and is required for government contracts or grants. You can request or look up a DUNS number here
Key Personnel: Please list key persons whether paid or unpaid who will support the implementation of the grant.KEY PERSONNEL
Please list key persons whether paid or unpaid who will support the implementation your health work. *Note: Please include theDate of Birth for each position/title. Failure to provide this information may result in a delay in the processing of the application.
Position/Title / Full Name
(First name, Last name) / Percent of time
(100% = fulltime) / Date of Birth*
(Day, Month, Year)
Name on Account:
ABA/ Routing Code:
Corresponding Bank Name:
Corresponding Bank Address:
Additional Wiring Instructions:
- Objective, Activities and Overview
Definition of Objectives: Specific, time-related targets that describe the tangible outcomes that the project will accomplish. The project objectives should be clear, measurable and concise statements of the major intended outcomes of the project, i.e., the major changes that were expected to be made by the participants.
A simple acronym used to set objectives is called SMART objectives. It is important that Expanding Health project objectives are written with this principle in mind. SMART stands for:
- Specific – The description of the objectives to be achieved should be clear.
- Measurable – The level of success in achieving the objectives should be measurable.
- Achievable – The likelihoodof success in fulfilling the objectives should be reasonable.
- Relevant – The benefit of success in fulfilling the objectives should be obvious and meaningful.
- Time-Bound – The achievement of the objectives should be within a prescribed time frame.
1. Increase health care provider knowledge of how to better meet the health needs of people with ID, as evidenced by the provision of training for at least 75 health care professionals during the project period.
Please create an objective(s) based on the above guidelines for your focus area (Follow-Up Care; Wellness Opportunities). In setting your objective for your project, each Special Olympics Program will need to determine what specific and locally relevant health issues to focus on rather than making the objectives too broad and lofty considering the resources available.
Please write your objective(s) in the space provided below:
Definition of Activities: The activities describe the tasks or actions you will carry out to work towards achieving your objectives and ultimately your goal. Each objective written above should have associated activities.Try to be specific and list activities in order of what needs to be accomplished.
1. Planning an interdisciplinary clinician workshop for newly trained clinical directors and volunteers focused on common health issues found in people with ID.
Please write your activities in the space provided below:
Please provide additional information regarding your1-year Healthy Community grant in the space below. Please make sure to answer the following questions:
-Describe which of the twofocus areas (Follow-up care; wellness opportunities) you will implement, the problem that you are trying to address and an overview of what you will do to address it.
-What have you done previously or what strengths does your Program have that will help the success of this project?
-Who is your target audience or beneficiaries of the grant (athletes, health care providers, families, coaches)? Will people with ID other than athletes or non-Special Olympics families of people with ID be included?
-How will you involve athletes in the planning, implementation and/or evaluation of the project?
-Do you have any existing partnerships which will support your project? What will they provide (cash, services, VIK, training, etc.)
-How will you ensure that the project and its impact are sustainable after the grant ends?
It is valuable for Special Olympics International to learn about your plans to use the 1-year Healthy Community Grant to achieve Healthy Community recognition so that we can connect you to the right resources and help you track your progress. Please answer the questions below.
Geographic Region: SO Programs are encouraged to focus their work in geographic area(s) within their SO Program and then apply learnings and successes to additional geographic areas. The minimum requirement for a SO Program to receive Healthy Communities Recognition is one geographic area. Have you identified a particular area or region within your Program that the 1-year Healthy Community grant will be focused? Please describe this area(s) and the estimated athlete population.
Criteria 2 - Local Funds and Support: Please estimate what percentage of your total Healthy Athletes event costs over the last year were funded by local (non-Special Olympics International) funds including VIK services? Note: VIK services include any service or item that is provided to support the Healthy Athletes event including transport, Special Olympics staff time, volunteer time, clinical space, food, equipment and giveaways.
Criteria 3 - Healthy Athletes: Please list the Healthy Athletes disciplines your Program is offering in 2017.Disciplines Offered / Approximate Number of Exams Provided per Year
If applicable, which additional disciplines will you add to achieve Healthy Communities recognition (a minimum of three are required)
Criteria 4 - Follow-up Care: If applicable and your Program has done work around follow-up care,what percentage of athletes receiving a referral after a Healthy Athletes event have a place to go for treatment?Please estimate to the best of your ability for each discipline your Program offers.
Note: For athletes that are given a referral (as indicated on the HAS form), they either indicate they already have an existing doctor/dentist that they will book an appointment with or the SO Program connects the athlete to a specific health care provider, partner, or place to go to receive the care they need. Special Olympics wants to ensure as many athletes receive care as possible. SO Programs are to establish partnerships to ensure that their athletes have a place to go to receive care for their referrals.Discipline / % of referred athletes with place to go / Method of tracking
Criteria 5 – Health, Wellness and Fitness Programming outside of Healthy Athletes: If applicable, please estimate what percentage of your athletes, within the geographic area selected for participation in Healthy Communities, are currently engaged in Health, Wellness or Fitness Programming outside of Healthy Athletes
Please insert a detailed timeline for planning, activation and evaluation of grant. The grant begins on 1 April 2018 and ends 31 March 2019. One way to do this is to assign completion dates to the activities that you listed above.
- Project Budget
Project Budget Guidelines
Please complete the attached budget templateprovided for all relevant project expenses. Make sure to:
- Provide a brief detailed description, cost breakdown and justification for all expected expenses listed in the budget. For example, for meals indicate the number of participants x the cost per meal.
- Complete the Value in-kind (VIK) tab.
An example budget template can be found here, please follow this level of detail when you are completing your budget:
What can be covered under the grant?
-The grant funding may be used to develop partnerships and implement the activities that will lead to follow up care plans and/or additional wellness and fitness opportunities for athletes.
-Some or most of the grant funding can cover salary for the staff person facilitating the grant and doing the reporting. The amount for salary depends on the local costs and the type of project. Some project’s such as partnership development may involve only staffing costs.
-The grant funding is not to be used for covering part of the Programs existing overhead costs such as office, internet and photocopier rentals. Each expense will need a receipt submitted for approval at the end of the project period.
-The grant funding can support aspects of Healthy Athletes related to follow up care, but it cannot cover standard Healthy Athletes event costs. Healthy Athletes events are covered through the standard process of capacity grants.
Note: The maximum grant amount awarded is $20,000 USD. However, not all Programs will receive the full amount. The amount requested should reflect the operating and staffing costs in the country and the scale of the project (number of athletes/stakeholders impacted).
- Evaluation Plan
As part of a Program’s commitment to receiving a 1-year Healthy Community Grant, Programs will participate in monitoring and evaluation efforts by collecting and providing data on performance measures and objectives. Monitoring and evaluation efforts will include both quantitative and qualitative process and outcome measures. Data collection will be a joint effort between SOI and Programs. Below is a summary of the commitments for all Programs implementing a 1-year Healthy Community Grant.
The reporting requirements will be as follows:
- Brief narrative mid-year progress report,due 15 October, six months after project implementation begins.The report will be submitted online
- End of year report with financial statements are due on 15 April 2019. A final budget and all receipts for funding spent will need to be submitted.
- End of year report covering detailed metrics and outcomes of the project. Programs will be provided a link to complete this report. The report will be covering the metrics in the tracking tool. Programs are encouraged to use this through the course of the project, which will make reporting on metrics at the end of the year easier.
- Join conference calls as needed (calls may be organized to provide technical assistance and guidance as needed).
Note: All 1-Year Healthy Community Grantees will be invited to participate in monthly Healthy Community webinars.