OHIO COLLEGE HEALTH ASSOCIATION
MINI-GRANT FUNDING
September 30, 2014
To All Members of ACHA in Ohio:
Enclosed in this envelope is an application for a Mini-Grant from the Ohio College Health Association (OCHA). This year the OCHA Board will award ONE $1500 grant.
This grant is awarded to a college or university submitting an educational, promotional, or research based proposal for funding. OCHA Board members review the proposals and grants are awarded at the OCHA annual meeting on Friday April 10, 2015.
Please complete the application following the written instructions and submit it to me no later than January 31, 2015 at the address listed below. This grant will be used during the 2015-2016 academic year. All applicants must be a member of the AmericanCollege Health Association for eligibility in the grant process; this status must be indicated on the application. Colleges and universities that are awarded the grants must report back to the board or at the annual OCHA conference of the outcomes and impact of their grant in the form of a brief oral presentation, poster presentation or letter to be read by a Board Member if they are unable to attend.
The grant application may be downloaded by visiting the OCHA webpage at
Please let me know if you have any questions.
Karen Borneman, M.D.
OCHA Mini-Grant officer/Board Member-at-large OCHA
Cleveland State University Health Services
1836 Euclid Ave. UB 263
Cleveland, OH 44115
Ohio College Health Association
Mini-Grant Funding Application 2014-2015 Academic Year
Grant to be used for 2015-2016 Academic Year
IMPLEMENTING COLLEGE/UNIVERSITYDate
Principal Investigator
College/University
Health Service Name
Address
Address
Telephone Number
Fax Number
P.I. e-mail
Contact Person/Phone
ACHA Identification # ( indicate if institutional or individual)
OCHA Requested Funding:
(up to $1500) / University Contribution:
(if applicable) / Total Funding:
Classification: Educational Promotional Research Other:______
Educational: Purchase/provide health-related educational materials
Promotional:Provide health-related marketing concerning health care facility services and/or other health-related issues
Research:Supplement cost of health-related research activities
Other:Equipment, public service, etc.
If funding is being requested for a program, please indicate proposed start/end dates:
______to______
______
Signature of Principal Investigator
University / Cleveland StateUniversityStudentHealthCenter
Address / 1836 Euclid Ave. UB 263
Address / Cleveland, OH44115
Telephone / 216-687-3649
Fax / 216-687-9319
e-mail /
INSTRUCTIONS
1.Return the completed form to the above mini grant officer by January 31, 2015.
2.Please allow eight to ten weeks for processing and for a Board decision. Grants for the 2015-2016 academic year will be officially awarded at the OCHA annual meeting in April 10, 2015.
3.You will be notified by mail, or please feel free to call the mini grant officer.
4. Printed materials should include the statement:FUNDING PROVIDED FULLY OR IN PART BY THE OHIO COLLEGE HEALTH ASSOCIATION.
- All applicants must be an ACHA member for eligibility in the grant process. Visit our web site at < to download or print out the application form. Return the application to:
- Karen Borneman, M.D. 1836 Euclid Ave UB 263 Cleveland, OH 44115
- Grant recipients are expected to do a brief verbal or poster presentation at the 2016 OCHA Annual Meeting
FUNDING DESCRIPTION/PROGRAM ABSTRACT
Please summarize information about the program (may type on separate sheet(s) of paper if desired).
GENERAL INFORMATION:
OBJECTIVE(S):
PURPOSE:
TARGET POPULATION:
RANGE OF SERVICES PROJECT WILL PROVIDE:
BUDGET:
Reviewed by OCHA Board and Officers-Kim Cullers CRNP, OCHAPresident , Karen Borneman, OCHA Mini-Grant Officer, Lois Wells, OCHA Treasurer