17's mission is to promote healthier people and healthier by eprITM4m

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									                                   CHNA 17
                   Arlington Belmont Cambridge Somerville Waltham Watertown



    CHNA 17's mission: To promote healthier people and healthier communities by
 providing a forum to identify, prioritize, collaborate, design and track local and regional
          health promotion strategies and to tell the stories of lessons learned.


                       Youth Grants Concept Letter Format

There are two stages in this competitive process:
1) Applicants will submit a concept letter that describes the project.
2) Applicants whose concept letters have been accepted will be invited to submit a full
proposal.

First Stage Submit the following by: June 30, 2011

1) Cover Sheet (attached)

2) Concept Letter: All letters must include the following (must not exceed 2 pages, 11-
12pt. type, single spaced with one inch margins).

   a)   Brief description of the organization
   b)   Brief description of the health priority, target population and need
   c)   Outline of project activities, over all goals and specific objectives
   d)   Identification of at least one collaborative agency
   e)   One page preliminary budget (not included in 2 page limit, optional template
        provided)

3) Budget:
Prepare an initial budget estimate. Please complete every line in the following table
using your best judgment when projecting project expenses.

4) Demonstration of nonprofit status: May be by an IRS designation as a 501 (C3) or
   other tax-exempt form indicating municipality or other non-profit status.

Submission Requirements
Both Electronic and hard copy submission is required.
Concept letters must be postmarked and emailed by June 30, 2011 at 5pm to be
considered.
1) Email copy of your application cover sheet, concept letter, budget and documentation
of non-profit status to:
ssimonechna17@gmail.com

2) Submit one original and five copies of the letter and application cover sheet to
the following address:

CHNA 17 c/o
Regional Center for Healthy Communities
552 Massachusetts Ave, Suite 203
Cambridge, Ma, 02139
                                  CHNA 17
                  Arlington Belmont Cambridge Somerville Waltham Watertown




                      CHNA 17 Youth Grants Concept Letter



Project Title:


CHNA towns that project will impact:
Is this a ___new project, ___existing project or an ___expansion of an ongoing project?


Lead Agency:
Primary Contact Person:
Email:
Secondary Contact:
Email:
 Address                                           Telephone:
City:                                              Fax:
State:
Amount of Funding Requested:

Fiscal Contact (if different than above):

Fiscal contact phone number:
      Address:
                                     CHNA 17
                    Arlington Belmont Cambridge Somerville Waltham Watertown

                               CONCEPT LETTER BUDGET FORM
   PLEASE GIVE AN ESTIMATE OF THE FUNDING YOUR AGENCY WILL REQUEST IN THE FULL
                               APPLICATION PROCESS.



                         Line Item                                   Funding Request

  Staff (Indicate number of hours to be applied to this
  project and hourly rate.)
  Fringe
  (if applicable)
  Contract Services

  Travel
  Supplies

  Equipment
(Capital expenses may not exceed 10% of budget
requested.)

  Agency Overhead
(May not exceed 10% of budget requested)

  Other Expenses (list and explain)


                          TOTAL

								
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