Take Action, Keep Educated (Take) Project

GRANT OPPORTUNITY

TAKE ACTION, KEEP EDUCATED (TAKE) PROJECT

MINI-GRANTS

Instructions and Application Forms

Proposal Submission Due Date:

May 5, 2008

3 PM, EDST

to

Point of Contact:

Dana Greer, Director

Office of Procurement Services

GeorgiaDepartment of Community Health

2 Peachtree Street, NW, 35th Floor

Atlanta, GA30303-3159

Tel: (404) 651-7987

Page 1 of 32

TABLE OF CONTENTS

I.PURPOSE

II.BACKGROUND

III.ALLOWABLE COSTS UNDER THIS RFGA INCLUDE:

IV.UN-ALLOWABLE COSTS:

V.ELIGIBLE RECEIPIENTS OF THE GRANT:

VI.APPLICATION REQUIREMENTS

VII.TIMELINE

ATTACHMENT I...... 12

STATEMENT OF ETHICS

ATTACHMENT II...... 17

DCH ETHICS IN PROCUREMENT POLICY

ATTACHMENT III...... 27

BUSINESS ASSOCIATE AGREEMENT

1

Request for Grant – Phase One

Georgia Rural Health Safety Net Program

PROGRAM DESCRIPTION AND REQUIREMENTS

I.PURPOSE

II.BACKGROUND

• Raise awareness, educate, and empower people about their health issues and health issues in general;
• Serve as a clearing house for women’s and men’s health related information;
• Develop policies and plans that support community partnerships and actions to identify health problems and work to solve them;
• Link persons who are in need of personal health services with various health professionals, facilities, etc.;
• Evaluate the effectiveness, accessibility, and quality of personal and population-based health services;
• Assure a competent public and personal health care workforce;
• Conduct research to identify new insights and innovative solutions to health problems;
• Foster awareness of current health crisis affecting specific ethnic populations; and
• Encourage physical activity, healthy dieting and other positive behavioral lifestyle changes.

Request for GrantPage 1 of 46

HIV/AIDS TAKE Project Mini-Grants

1. THE PROGRAM

1. Expand and/or enhance advocacy plan;
2. Increase access to mental health services;
3. Increase access of HIV+ persons to care/treatment services;
4. Reducing stigma and increasing awareness of HIV/AIDS; and
5. Expanding/enhancing HIV testing services.

1. Deliverables:

1. A work plan that includes the goals, objectives, activities and expected outcomes within thirty (30) days of the start of the contract;
2. A six (6) months project report within thirty (30) days of the first six (6) months of the contract agreement and a final report within forty-five (45) days of the end of the funding cycle;
3. Samples of all materials used in the project with required reports; and
4. An expenditure report for all cost (based on the submitted budget of allowable expenditures) along with the required reports.

1. THE CRITERIA FOR THE AWARD OF THE GRANT:

1. Agency Overview

1. Experience in providing effective HIV prevention, intervention and/or care services.
2. Demonstration of Responsible Administration and Accountability of Funds.
3. Agency’s Overall Mission Statement. Must show how agency’s overall mission statementrelates to the statement of purpose in this RFGA.

1. Target Population

1. Description of the Target/Priority Population(s). Identify Priority Area (s) Targeted By The Proposal And How It Relates To The Needs Of Your Community (See Paragraph III)

1. Project Goals. Must include what the project intends to accomplish and show how it relates to the overall goal of the RFGA.

1. Chosen Intervention(s)/Activity(ies). Must provide descriptions of what services are being delivered and the frequency of delivery; must show if proposed programs are of sufficient duration and intensity and if they promote change.

1. Project Overview

1. Project Objectives. Must state how many times the program will conduct the activity(ies); how many people will participate; how many objectives for each activity and are they measurable, realistic and time-based.
2. Action Steps. Must provide an implementation plan with specific steps related to the project and objectives, which must include the start date, completion date and the person(s) responsible for completing each action step and show how they are implemented in settings that are easily accessible to the target population.
3. Outcome Measures/Evaluation. Must show the outcomes and their potential benefit to the client after receipt of service; how outcomes are measured; evidence found to indicate program success, please be specific; and what evaluation tool(s) will be used. Please include a sample of an evaluation tool(s) previously used for projects similar to this RFGA.
4. Demonstration of a Clear and Well-Written Application, which includes adherence to the application format.

1. Level of Participation/Involvement in the Community of Practice

1. Level of Participation in the TAKE Project’s HIV/AIDS Community of Practice (CoP). If not a current member of the CoP, does the applicant show intent to become a member if awarded?
2. Collaborative Efforts. Must show collaborative efforts established with other agencies (especially those conducting HIV/AIDS activities); efforts to minimize and prevent duplication of services; and efforts to establish linkages with other agencies.

1. Program Budget

1. Amount applying for.
2. Demonstration of Cost Effectiveness. Must show evidence that the agency have matching funds, volunteer participation, or in-kindcontributions.

1. GENERAL TERMS AND CONDITIONS OF THE GRANT

III.ALLOWABLE COSTS UNDER THIS RFGA INCLUDE:

1. Salaries and benefits;
2. Travel, in accordance with the State of Georgia’s Travel regulations which may be found at www2.state.ga.us/Departments/AUDIT/m&lg/travlreg.html;
3. Direct costs (e.g. supplies, postage, copying, telephone, educational materials, pamphlets, videos and brochures);
4. HIV/AIDS prevention/intervention subscriptions and applicable periodicals with prior approval by contract manager;
5. Incentives and/or promotional items and some promotional items or incentives (i.e. food coupons) can be reimbursed with prior approval by contract manager;
6. Agency training and/or staff development associated with HIV prevention/ intervention and/or care; and
7. Advertising related to prevention/intervention, risk reduction and care/treatment messages.

IV.UN-ALLOWABLE COSTS:

1. Cash award to employees or ceremony expenditures;
2. Penalty on borrowed funds or statutory violations or penalty for late/non- payment of taxes;
3. Out of state travel;
4. Organizational affiliations, fund raising and public relations;
5. Deferred payments to employees as fringe benefit package;
6. Severance pay and unearned leave;
7. Food expenses, except those used as incentives and with prior approval by contract manager;
8. Alcoholic beverages;
9. Purchase of equipment or furniture; and
10. Staff overtime.

Request for GrantPage 1 of 46

HIV/AIDS TAKE Project Mini-Grants

V.ELIGIBLE RECEIPIENTS OF THE GRANT:

1. Be a public health agency or,
2. Be a faith or community-based non-profit corporation under the Internal Revenue Services Code 501(c)(3) registered as such and in good standing with the Secretary of State for the State of Georgia at the time of application.

VI.APPLICATION REQUIREMENTS

1. Clearly typed (typewriter or computer);
2. No more than five (5) pages long, excluding title page indicating name and address of applying agency; contact person; phone number and e-mail address, if any; copy of a current and valid letter/certification of applicant's Certified 501(c)(3) status; and proof that status is valid with the Georgia Secretary of State’s Office;
3. Single spaced on 8 1/2" by 11" paper with 1" margins;
4. Eleven (11) font size;
5. Printed on one side only; and
6. Submitted in a sealed envelope. Please do not paper clip, staple, or bind the documents.

1. Title Page (include Tax ID #), nonprofit designation and month’s entity’s fiscal year ends.
2. Proposal (no more than five (5) pages per agency):

1. Agency Overview
2. Target Population
3. Identify Priority Area(s) Targeted By The Proposal

1. Project Overview
2. Level of Participation/Involvement in the Community

1. Program Budget

1. Copy of a current and valid letter/certification of applicant’s Certified 501(c)(3) status; and proof that status is valid with the Georgia Secretary of State’s Office and a notation of the month in which fiscal year of your organization ends.

VII.TIMELINE

Request for GrantPage 1 of 46

HIV/AIDS TAKE Project Mini-Grants

Department of Community Health (DCH) Request for Grant Proposals

GA HIV/AIDS TAKE Project

Program Budget, 2008-09

Name of Agency: ______

Project Name: ______

EXPENDITURE CATEGORY*

BUDGETED EXPENDITURE

Authorized Signature

Print Name

Date

Request for GrantPage 1 of 46

HIV/AIDS TAKE Project Mini-Grants

ATTACHMENT I

DCH STATEMENT OF ETHICS

Preamble

The Department of Community Health (DCH) has embraced a mission to improve the health of all Georgians through health benefits, systems development, and education. In accomplishing this mission, DCH employees and any individual, group, contractor or grantee who receives funds from DCH must abide by this Statement of Ethics must work diligently and conscientiously to support the goals of improving health care delivery and health outcomes of the people we serve, empowering health care consumers to make the best decisions about their health and health care coverage, and ensuring the stability and continued availability of health care programs for the future. Ultimately, the mission and goals of the organization hinge on each employee’s commitment to strong business and personal ethics. This Statement of Ethics requires that each employee or previously defined party:

• Promote fairness, equality, and impartiality in providing services to clients

• Safeguard and protect the privacy and confidentiality of clients’ health information, in keeping with the public trust and mandates of law

• Treat clients and co-workers with respect, compassion, and dignity

• Demonstrate diligence, competence, and integrity in the performance of assigned duties

• Commit to the fulfillment of the organizational mission, goals, and objectives

• Be responsible for employee conduct and report ethics violations to the Ethics Officer

• Engage in carrying out DCH’s mission in a professional manner

• Foster an environment that motivates DCH employees and vendors to comply with the Statement of Ethics

• Comply with the Code of Ethics set forth in O.C.G.A. Section 45-10-1 et seq.

Not only should DCH employees comply with this Statement of Ethics, but DCH expects that each vendor, grantee, contractor, and subcontractor will abide by the same requirements and guidelines delineated. Moreover, it is important that employees and members of any advisory committee or commission of DCH acknowledge the Statement of Ethics.

Request for GrantPage 1 of 46

HIV/AIDS TAKE Project Mini-Grants

Ethical Guidelines

1. Code of Conduct

All employees of DCH are expected to maintain and exercise at all times the highest moral and ethical standards in carrying out their responsibilities and functions. Employees must conduct themselves in a manner that prevents all forms of impropriety, including placement of self-interest above public interest, partiality, prejudice, threats, favoritism and undue influence. There will be no reprisal or retaliation against any employee for questioning or reporting possible ethical issues.

1. Equal Employment

The Department is committed to maintaining a diverse workforce and embraces a personnel management program which affords equal opportunities for employment and advancement based on objective criteria. DCH will provide recruitment, hiring, training, promotion, and other conditions of employment without regard to race, color, age, sex, religion, disability, nationality, origin, pregnancy, or other protected bases. The Department expects employees to support its commitment to equal employment. The failure of any employee to comply with the equal employment requirements provided in DCH Policy #21 may result in disciplinary action, up to and including termination.

1. Harassment

DCH will foster a work environment free of harassment and will not tolerate harassment based on sex (with or without sexual conduct), race, color, religion, national origin, age, disability, protected activity (i.e., opposition to prohibited discrimination or participation in a complaint process) or other protected bases from anyone in the workplace: supervisors, co-workers, or vendors. The Department strongly urges employees to report to the Human Resources Section any incident in which he or she is subject to harassment. Additionally, any employee who witnesses another employee being subjected to harassment should report the incident to the Human Resources Section. If DCH determines that an employee has engaged in harassment, the employee shall be subject to disciplinary action, up to and including termination, depending on the severity of the offense.