Walk With Ease Self-Directed Mini Grant Funding Opportunity

2017 Application

Purpose: The purpose of this program is to increase access to arthritis-appropriate evidence-based interventions (AAEBIs) among adults living with arthritis. Federal funds will be awarded to American Physical Therapy Association state chapters and physical therapy (PT) practices to deliver the Walk With Ease Self-Directed program.

APTA State Chapter or
PT Practice
Please provide a brief description of chapter size (number of PT, PTA and student members) or PT clinic’s staff makeup
Mission
Services provided to members

Is your APTA state chapter or PT practice able to directly enter into an official memorandum of understanding with the National Association of Chronic Disease Directors? All applications will be considered regardless of response.

Yes

No

Unsure

Please provide contact information for the following APTA state chapter representatives:

Chapter President
Chapter Legal Contact
Chapter Finance Contact

Please provide the following for person completing this form:

Name
Work Title
Organization
Email

Project Description

Proposed Arthritis-Appropriate Evidence-based Intervention
Walk With Ease Self-Directed
Target population. Please describe if target population resides in an urban versus rural area, represents minority or non-minority populations, etc.
Descriptive project title
Estimated number of adults reached
Potential partners
Describe project goals
Describe chapter or practice’s proposed activities and role of partners
If your state has a CDC-funded state arthritis program but you have not listed this program as a potential partner, describe how you might partner with the state arthritis program to complete services.
Sustainability plan (plan to sustain project efforts after grant funds are used)
Plan for evaluating new services or new collaborative partnership formed to complete project activities

Proposed timeline: Briefly describe activities to be completed during each month of the project period.

Project period: November 1, 2017 – August 2018 (tentative)
November
December
January
February
March
April
May
June
July
August

Proposed budget: Please describe how your APTA state chapter will use awarded funds

Example: Personnel / $1,500; state chapter will use funds to provide funds for administration support.
Personnel
Supplies
Equipment
Shipping and Postage
Other (please describe):
Total amount requested

2017 Application Page 1