Request for Proposal

2016 Oral Health Mini Grant Awards

Cycle #8

Important Dates

Project Period: January 1, 2016 through August 31, 2016

Funding Announcement Release: November 1, 2015

Application Deadline: December 4, 2015

Notification of Funding: December 18, 2015

Final Report Due: September 15, 2016

Dental Support Center

2016 Mini-Grant Awards Guidelines

1.  Eligibility

All California Tribal/Urban Dental Health Programs are eligible. Each proposal that is accepted will be funded up to a maximum of $ 3,000. Approximately eight (8) projects will be funded.

2.  Funding Priority Areas – Projects should focus on one or more of these priority areas.

·  Projects that serve AI/AN infants, children, or youth

·  Projects that serve oral health needs of AI/AN adults (diabetes, geriatric, oral cancer, smokeless tobacco use, meth mouth, etc.)

·  Projects that improve the oral health of AI/AN pregnant women

·  Project that promote IHS Initiatives (ECC, Periodontal Disease)

·  Projects that improve GPRA measures

3.  Funding Limitations

·  Funds may be used to purchase equipment and supplies, and/or to implement and administer initiatives.

·  The project funds may not be used for food, or other overhead costs.

·  Grant proposal should be limited to no more than six (6) pages including the grant cover page.

4.  Grant Period

·  January 1, 2016 through August 30, 2016

5.  Grant Award Requirements

·  Final project reports (see attached final report format). Straightforward reporting requirements.

·  All tracking measures/evaluation

·  Original receipts related to project activities

·  Awardees may be selected to present a poster session at the 2016 Dental Conference in May 2016.

Once a program is officially notified of funding, project expenditures will be reimbursed upon submission of these award requirements. All mini-grant funds should be requested and invoiced by the date noted in the Mini-Grant Fund Agreement.

6. Cover Page

Name of Organization: ______

Name and Title of Contact: ______

Person Authorized to Sign if Different Than Contact: ______

Telephone: ______FAX: ______E-mail: ______

Address of Tribal/Urban Dental Program: ______

______

______

Organization’s Federal ID Number: ______

Project Title: ______

Project Date/Dates: ______

Amount Requested: $______

Signature of person authorized to sign on behalf of organization:

______

Signature/Title Date

7.  Project Proposal - Please answer the following questions. Funding of your application will be based on your responses.

A.  Which oral health priority area(s) will your activity address? (Check all that apply.)

( ) Projects that serve AIAN infants, children and youth

( ) Project that focus on oral health needs of AI/AN adults (diabetes, geriatric, oral cancer, tobacco use, meth mouth etc.)

( ) Project that targets AIAN pregnant women.

( ) Project that that promotes IHS Initiatives (ECC, Periodontal Disease)

( ) Project that improves GPRA measures

B.  Project Summary

C.  Describe briefly the need for the proposed project in your community.

D.  What are your Goals for this project? What is the anticipated impact of your project on your community?

E.  What are your Objectives for the Goals? Please use the SMART objectives format. (Specific, Measurable, Achievable, Realistic, and Timeline).

· 

F.  Describe the activities you would be conducting in order to achieve your objectives. (Methodology)

G.  Who will be conducting the above mentioned activities? Describe their role in the activities, including the locations of the activity sites for the project. Use additional pages if needed.

H.  How and when would you monitor the progress of your project?

I.  Describe the approximate number of AI/AN people your activity will serve.

Adults ______Youth ______Children ______

J.  What challenges do you anticipate?

K.  How will you evaluate your project? What tracking measures will you provide with your final report? (Please list all that apply and please be specific)

L.  Would you be reporting GPRA measures generated by this project to Indian Health Service California Area Office? Yes No

M.  List any partners or collaborations for the project (if any). Letters of support from your project partners may be submitted as additional attachments.

8.  BUDGET - Project Budget (not included in 6 page limit). This is only a sample. Please make your budget appropriate to your project needs)

Project Name: ______Project Location: ______

Project Period: ______

Category / Amount
1.  Supplies (describe item/amount) / $
·  / $
·  / $
·  / $
2.  Other
3. 
4. 
TOTAL BUDGET

Please list in-kind contributions, if any. ______

Grant proposal due date: Friday, December 4, 2015

Mail, FAX, or e-mail your grant application to:

Lalani Ratnayake, Dental Support Center Coordinator

California Rural Indian Health Board, Inc.

4400 Auburn Blvd., 2nd Fl.

Sacramento, CA 95841

Phone: (916) 929-9761 FAX: (916) 929-7246

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