2018 “Solano Moves” Mini-Grant Program

Proposal Application

Improving Walkability and Increasing Physical Activity in Solano County

Guidelines: Refer to “Request for Applications”

All proposals should be electronically submitted as a Microsoft Word document .

Title: ______

Application Date: ______

Applicant Name: ______

Organization Name (if applicable): ______

Population Served (brief description):______

Geographic Area Served:______

Phone Number: ______Email: ______

Please attach your answers along with a completed W9 and vendor application (attached)

  1. Description of Project (400-word limit) (See example below)

Include in your project description a description of the current conditions of the neighborhood/community to be served (i.e., residential area, sidewalks, trails, parks, etc.) and identify your prospective partners and discuss who you are and what your interests are.

EXAMPLE: I am a parent and want to start a walking group with other parents in our neighborhood, after our kids are home from school. As a parent, I find it difficult to find time to exercise and have found other parents in the neighborhood who feel the same. Other challenges include safety if I am walking alone and motivation. I have spoken with 4 other parents in my neighborhood that are interested and plan to recruit at least 5 more for a total of 10 parents. We will meet weekly and walk for one hour.

  1. Implementation Plan (300-word limit) (See example below)

How will you start a new walking group, promote to others and/or recruit participants, connect with already-existing efforts, or raise community involvement:What problems currently exist or can potentially exist,that you are planning to address and what do you think the solution could be, that can be accomplished within the scope of this project?

EXAMPLE:(e.g., flyers, promotion through social media, door-to-door invitations, tabling at community events: One problem that can potentially exist is retaining participants and/or sustaining the walking group. One solution for this problem is to partner with the Parent Teacher Association at my child’s school to collaborate on efforts to recruit more participants and sustain the walking group.)

  1. Evaluation/Assessment (200-word limit) (See example below)

Identify what the goals/objectives will be for your project.Describe how you will evaluate the effectiveness of your project

EXAMPLE: Goal- Start walking group with other parents from my child’s school and others in my community.Objectives- Increase members of the walking group by posting fliers, social media promotion, etc.; In one month, get more members in the walking group. In two months, connect with community leaders, etc.

Evaluation/assessment-Documentation of increased membership, pictures of group walks, documentation of infrastructure proposals to improve walkability; and so on.

  1. Funds Requested – Awards up to a maximum of $2000 (See example below)

Present your budget and description of what you plan to purchase. Determine specific needs you have to create this project and how much they cost.

Indicate total amount requested, and a breakdown of the total costs.

Please note, the funding cannot be used to pay for food unless it is part of a room reservation.

EXAMPLE:

Type / AmountRequested / Description
FacilityRentals / $100 / Facility rental to host a recruitment event at my child’s school
Promotion/Advertising / $500 / Develop and print flyers/signs that anyone can post
TrainingMaterials / $200 / Supplies to host a training on how to conduct a walkability audit in my community
Supplies/Postage / $200 / Printed materials and a binder for each participant in the walkability training
Signage/Prompts / $1000 / Develop signage/prompts for my neighborhood park (requires partnership/approval from governing authority)
Other / $
Other / $

ApplicantSignatureDate

NOTE: InadditiontothisApplication,ifthefundingisapproved,Applicantmustreadandsignthe“AgreementforSolano Moves Mini-Grant Program”.

Solano County Public Healthuseonly

Received:

SPMeetingDate:

ApprovedbyCommitteeYes/NoAmountapproved:

Notes: