South Shore Community Partners in Prevention

South Shore Community Partners in Prevention

Community Health Network Area (CHNA 23)

Serving the Communities of:

Carver n Duxbury n Halifax n Hanover n Hanson n Kingston

Marshfield n Pembroke n Plymouth n Plympton n Rockland

2017-18 Mini-Grant Application

Name of Organization*:

Address:

Contact Person:

Phone: FAX: Email:

How did you hear about the SSCPP grant?

*Please provide a brief organizational description and/or mission statement here. This item is not scored during review of applications.

This request for funding is for a maximum mini-grant award of $3,500.

Mini grants will be reviewed four times a year. To ensure timely review of your application, please submit grants by the following deadlines. South Shore Community Partners in Prevention steering committee members will review the grants each quarter.

Fall: Applications due October 15th (Funding notifications November)

Winter: Applications due January 15th (Funding notifications February)

Spring: Applications due April 15th (Funding notifications May)

Summer: Applications due July 15th (Funding notifications August)

Application Instructions

·  Please use a 12-point font, single-spaced text, and a 1-inch margin on all sides.

·  Answer each question completely and concisely. Page limitations for each question are provided below. All questions in the application are weighed equally.

·  Send applications to the CHNA 23 Coordinator, via e-mail at or by mail to United Way of Greater Plymouth County, 934 W. Chestnut Street, Brockton, MA 02301, ATTN: CHNA 23

·  The SSCPP Steering Committee may require you to be available during the review of your application either in-person or via telephone.

Eligibility

·  The proposed project must benefit one or more of the 11 communities in the South Shore Community Partners in Prevention Community Health Network Area (CHNA 23). Please see the list of communities on the page header above.

Additional Requirements

·  Successful applicants will be invited to send a representative to a SSCPP meeting to receive the mini-grant check and to provide a brief (5 minute) overview of the project.

·  Mini-grant funds must be spent within one year of the award notice.

·  Please plan to present your project outcomes at a SSCPP meeting at the conclusion of the project.

·  A written outcomes project report is required. A template for the report will be provided.

·  Events, materials, and other communications that are associated with the project funded by this mini-grant must acknowledge support from South Shore Community Partners in Prevention. The following is suggested language: [Project Name] is funded [in part] by a mini-grant from South Shore Community Partners in Prevention, Community Health Network Area (CHNA 23).

·  A press release on the initiative is also required. Please send a copy of the press release to .

1. Briefly describe the project/event for which funding is requested. Include the population to be served, number of items/cost per unit, project timeline, and town(s) to be served. Describe how you identified the problem that the proposed project will address. Page limit: one page

2. Briefly indicate how your proposed project meets the following South Shore Community Partners in Prevention priorities:

·  promote nutrition and physical activity

·  address the needs of special/vulnerable populations

·  improve access to health care

·  improve health literacy

And/or the following Massachusetts Department of Public Health priorities

·  eliminating racial and ethnic health disparities and their social determinants;

·  promoting wellness in the home, workplace, school, and community; or

·  preventing and managing chronic disease

Page limit: one-half page

3. Provide a complete project budget using the attached form. Include the following:

·  amount of funds requested from South Shore Community Partners in Prevention;

·  additional funding sources supporting this project; and.

·  narrative description of budget line items

Page limit: one-half page

4. List your desired outcomes for this project. Describe how you will know that your desired outcomes have been achieved. Page limit: one-half page.

SSCPP | August 2017