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Grant Proposal Sample - DOC

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					                                                 SAMPLE GRANT PROPOSAL

                                                        I. Chapter Name

II. Project Leaders and Chapter President addresses, telephone numbers, emails

III. Project Description and Abstract
  A. Project Description: Low-income communities of color suffer a disproportionate burden of environmental hazards,
       which correlate with high rates of chronic diseases such as asthma, diabetes, and cancer. To address the limited
       attention given to these issues in the curriculum, students will participate in a 4-hour guided bus tour of toxic sites in
       the community, a low-income neighborhood with a large African American and Latino population. Working with the
       Coalition for Environmental Justice, participants will meet with local residents and discuss ways that health
       professionals can help promote health and environmental justice. Photographs taken will be displayed in graduate
       departments.
  B. Abstract: Local health professional and graduate students will participate in a 4-hour physician-led local bus tour to
       highlight environmental hazards and work with community members to plan health justice action.

IV. Project Details
  A. Title: Environmental Justice Tour
  B. Number of local chapter member participants: 20
  C. Number of other health professional participants: 4
  D. Describe your target audience: 24 medical students and faculty will be selected as the main EJ Tour participants.
       Additionally, to expand the breadth of impact of this project, hundreds of people will be invited to view the poster
       display from the medical school, school of public health, nursing school, and pharmacy school, as well as local
       community members.
  E. Goal of Project (25 words): To introduce law, medicine, public health, and nursing students to community
       environmental justice issues, and to involve them in institutional and public policy change.
  F. How will you attain goals – Note specific measurable objectives to reach those goals? (50 words)
           1) Introduce environmental justice issues to students via bus tour by local physician activist.
           2) Document tour with digital photography for med school/community poster presentation.
  G. What other alternatives were considered? (25 words) We considered holding a weekend conference on
       environmental health issues, as well as a lunchtime lecture from an occupational medicine doctor.
  H. Why were they excluded? (25 words) We felt that a lecture or conference would be too broad and less powerful than
       experiential learning.
  I. AMSA resources: We reviewed www.amsa.org/global Global Health Action Committee website and contacted the
       Global Environment Coordinator for advice and educational resources to hand out, and will direct participants to
       AMSA’s legislative action center at www.amsa.org/legislativecenter for follow-up action.
  J. Please include timeline (note milestones, point of no return).
                                                                                                  th
            1) Tour date and initial communication with faculty established by October 15 .
            2) Publicity plan (email, class announcements, and fliers) and application system designed and posted by
                             th
                 October 20 .
                                                        th                                       st
            3) Applications posted by November 15 . Application deadline December 1 . Applicants and waitlist
                                       st
                 notified by January 1 .
                                                                   th
            4) Faculty participants finalized by November 15 .
                                                                                  th
            5) Environmental issue committees created by November 30 for tour follow-up action. Committees will meet
               every other week until the tour and will coordinate all follow-up.
                                                   st
            6) Van rental reserved by January 1 .
                                                             th
            7) Participant reminders sent out January 15 .
                                            th
            8) Tour date: February 5 , 2005.
                                                                                            th                  th
            9) Photo poster presentation and follow-up action groups meet February 15 and February 30 to create
               exhibit and plan action.
                                                                  th
            10) Photo poster presentation week of March 1-7 in main lounge.
                                                                             th
            11) Six-month reports due from committees on August 15 .
                                                                        th
  K. If problems arise, when will the goal be reached? March 5 .
  L. Evaluation (50 words): Pre- and post-tests on local environmental knowledge will be administered to all tour
     participants and used to inform issue committees in furthering curricular improvements. Written evaluations of the
     tour will be used to help future planners and evaluate project impact. Committees will issue culminating report at
     school meeting 6 months after tour.
  M. If you feel as if your AMSA chapter is struggling, please comment on why and how this project may help develop
     local AMSA activity: Our AMSA chapter is already quite active.

V. Resource Requirements:
  A-E. List of applicable resources
  F. Participation will not be limited to any specific group.

VI. Finance and Budget
    A. Has this project ever received previous AMSA Local Project Grant funding? No.
    B. Has this project been done before? No.
    If so:
              1. How is this year different/improved from previous years?
              2. How was the project funded in the past (please be specific--local chapter, school, outside grant, LPG)?
    C. What additional funding sources were considered for the project this year? Have you planned to obtain any
         resources from the following?
1. Local Chapter Contribution                $ 100.00
           2. Collaborating Groups (specify)          $ 100.00 (Graduate Student Council)
           3. Other (specify)                         $ 75.00 (discount from van rental company)
     4. AMSA (amt. requesting)               $ 228.20

                  TOTAL                                         $ 503.20




    D. Required precise, itemized project budget. Please use the chart format below. Note: AMSA will                  NOT
    fund any requests for food, travel, or speaker honorarium.

Funding Amount              Item Description            Narrative/explanation        Anticipated Funding
Requested                                                                            Source

$ 96.00                     Teaching booklets:          Participants will receive    $96.00 – AMSA Local
                                ·   24 folders x        a small teaching booklet     Project Grant
                                    $1.00 = $24.00      containing pertinent
                                ·   15 black and        articles, community
                                    white double-       statistics, and
                                    sided copies x      community resources
                                    24 participants     related to the
                                    x $.20 =            Environmental Justice
                                    $96.00              Tour.

$ 3.00                      Publicity:                  We will utilize email        $2.00 – AMSA Local
                                ·    email and class    and class                    Project Grant
                                     announcements      announcements as well
                                     = free             as fliers to publicize the
                                ·    30 fliers x $.10   tour and reach as many
                                     = $3.00            faculty and students as
                                                        possible. Later we will
                                                        also announce the poster
                                                        display to the
                                                        surrounding graduate
                                                        schools and community
                                       via fliers.

$ 7.20     Evaluation:                 Pre- and Post-               $ 7.20 – AMSA Local
               ·    24 pre-            Evaluations will help        Project Grant
                    evaluation         determine what students
                    sheets: 24 x       and faculty have learned
                    $.10 = $2.40       from the experience and
               ·    24, 2-page         also evaluate the
                    post-evaluation    components of the tour
                    forms: 24 x 2 x    so we can improve it in
                    $.10 = $ 4.80      the future.

$ 275.00   Avis Van Rental:            Two vans are required to     $100 – Local AMSA
           ·   Two, 12 passenger       transport students to the    Chapter
               vans x 1 day, gas       various toxic sites          $100 – Graduate Student
               and van insurance       around the community.        Council
               included in price =     We could have had            $75.00 – Van company
               $275.00                 everyone carpool             discount
                                       separately, but then the
                                       in-van group discussions
                                       and teaching would have
                                       suffered.

$ 81.25    Digital Photo Printing:     The use of digital photos    $ 81.25 – AMSA Local
           ·   25, 5x7 inch digital    will allow participants to   Project Grant
               photos x $1.25 =        take many pictures and
               $31.25                  then we will be able to
           ·   25, 8x10 inch           develop only the best
               digital photos x $      ones for the presentation
               2.00 = $50.00           to the larger community.
                                       We decided that 5x7 and
                                       8x10 inch photos would
                                       likely be most moving.
                                       We may also submit
                                       them in our school art
                                       show and to the AMSA
                                       Healer’s Voice online
                                       art’s journal.

$ 40.75      Photo Presentation        Foam board is more           $ 40.75 – AMSA Local
             Boards:                   resilient and durable        Project Grant
           ·    10 foam boards x       than poster board. We
                $4.00 = $40.00         intend to reuse these
           ·    1 packet sticky tack   boards in future
                = $1.75                semesters as well.

TOTAL


$ 503.20