Describe the ways this request will improve health care outcomes.
Describe the problem or opportunity this grant will address.
Provide a summary of the request including specific goals and anticipated outcomes, as well as overall
timeframe with major milestones.
Describe how this request will be implemented including all facilities, people, equipment, and materials
that will be involved. Include major milestones and targeted completion date. Describe how outcomes
will be measured.
If this request involves collaboration between organizations, please list each one and their role.
List major line items and funds or support being requested.
Describe the source of budget assumptions. Include a justification for the cost of the program, as well as
an explanation as to how you arrived at estimated expenses and revenues, if applicable. If the program
is to be ongoing, how will funding be sustained?
List any sources that you are aware of that could provide or could be interested in providing support for this proposal. This list could include individuals, local businesses, corporations, associations, charitable organizations, foundations as well as local, state, or federal funding sources.
Please add any additional information for the review committee to consider.