Submit Application Via Email To

NNLM Pacific Southwest Region
Express Outreach Award Application

Submit application via email to:

National Network of Libraries of Medicine
Pacific Southwest Region (NNLM PSR)
Email:

Required Submissions (forms provided):

Cover Sheet
Project Information and Plan
Budget (including detailed narrative budget justification)
Direct Beneficiaries & Populations Targeted
NNLM Goals

Attach or send separately

Curriculum vitae of key personnel
Letters of support from applicant’s institution (optional)

Word format (.doc or .docx) is preferred.

Deadlines:

Applications will be accepted on a continuous basis.

Cover Sheet

Project Title:

Date of Submission:

Organization Name and Address:

Name and Address of Organization to whom payment will be made:

Institution DUNS Number:

Project Manager/Leader Name and Title:

Project Manager/Leader E-mail Address:

Among being requested:

Is your organization a member of the National Network of Libraries of Medicine Pacific Southwest Region?

Project Information and Plan

Project Title:
Proposed start and end dates for project:
Summary statement:
Provide a one paragraph summary of the proposed project to summarize the goal and objectives, the intended outcomes, and the work plan.
Describe the target audiences and need for your project:
Include demographics, health information assets and needs, and how this data was gathered. Explain why there is a need for information outreach to the target audience. Include an estimate on the number of individuals you expect to reach during the project. For more information on needs assessments, see publications of the NNLM Evaluation Office, in particularBooklet 1: Getting Started with Community-Based Outreach.
Identify the goals of the proposed project:

State the specific objectives to be achieved by the project:
Objectives should be stated in measurable terms. Include process objectives about what will be done (outputs) and outcomes-based objectives that specify what will happen or change as a result.Outcomes are the benefits you expect your project will have for individual participants and possibly the community, organization, or system.
Provide a detailed work plan (max 1000 words), and indicate a rationale for the plan.
Describe how the project will be implemented, and the products, strategies or services you will produce or carry out to achieve intended outcomes. If training and/or demonstrations are included as a methodology, describe what will be taught or demonstrated, who will do it, where it will be done, length of class, type of continuing education credit, what training materials will be used, and a description of the target audience for each event. Applicants are expected to use or adapt existing training materials before developing new materials. Consult the National Training Office to identify training materials already available ().
Evaluation plan.
Explain how the success of the project will be measured and the methods to measure that success. Evaluation should be tied to project goals and objectives. Members are strongly encouraged to consult the NNLM PSR or the NNLM Evaluation Office (NEO) publications and resources in developing an effective evaluation plan:
Award recipients conducting certain NNLM activities will be asked to collect specific information and report it at the end of the project using forms provided by the NNLM. If your project includes training, technology improvement, exhibiting/health fairs, or professional development activities, you will need to report this standard information. Please refer to the NNLM Evaluation Office’sNNLM Evaluation Materialsweb page for the type of information you will need to report. In your evaluation plan, explain how and when you will use the NNLM forms to collect the information,andinclude any additional evaluation that you are planning for the project.
Please provide a timeline for your project.
Provide a list of tasks in chronological order and indicate timeline for each task. The project should be completed by April 30, 2018. A no-cost extension may be requested if needed.
Identify all project personnel and their role in the project.
List types of partner organizations you will work with to carry out the project: (check all that apply)

☐State or Regional Health Organization

☐State or County Health Department

☐State Library

☐Public Library

☐Health Sciences Library

☐Academic organizations (please specify):

☐K-12 Library

☐Community organizations (please specify):

List name(s), address(es), website(s) if any and description(s) of partner organization(s) and key contact person.
Please complete the following budget form.

Project Information and Plan Budget Form[1][2][3]

Please use the budget form provided below and provide an itemized narrative budget justification. Note instructions given in the form, and allowable expenses listed below.

Budget Item / Description / Costs for performance period
from: [day/mo/yr] to [day/mo/yr].

Salaries[4]

Fringe Benefits[5]

Equipment

Travel[6]

Supplies

Other Costs

Total Direct Costs
(A+B+C+D+E+F)
Modified TDC (TDC minus Equipment)
Indirect Costs[7]
(MTDC*x%)
Total Costs
(TDC+IDC)

Allowable expenses: Personnel, equipment, supplies, travel and other costs such as reproduction of materials, software, Internet service provider fees. These are examples only and are not meant to be all-inclusive. Purchase of print materials is permitted, but must not exceed 5% of the direct costs.

Expenses are also allowed to publicize a health information service, event or resource, including National Library of Medicine (NLM) or National Network of Libraries of Medicine (NNLM) resources or services, but the allowable costs are limited to educational materials or publicity, such as posters, displays, flyers, bookmarks, or brochures. Please consult the policy at

Non-allowable expenses: Furniture is not allowed and food is not allowed unless certain circumstances apply. Please consult the policy under Meals at

Indirect Costs (IDC) or Facilities and Administrative (F&A) Costs: Indirect cost (IDC)/F&A can be included based on your institution's federally approved IDC agreement (non-research rates apply). A 10% MTDC rate may be used if no IDC agreement exists.

Additional Forms to be Included with Proposal

The following three forms must be included with your proposal. Please fill out the forms and submit them with your proposal.

Direct Beneficiaries
Populations Targeted
Goal Identification