Harris Grant RFP by keara


									Samuel D. Harris Fund for Children’s Dental Health Grants Program Grant Proposal Summary Form and RFP 2009-10 Program Year Note: all applicants please use this new 2009 application form
This is an MS Word Form. Save it to your computer and then modify it.

Name of Sponsoring Organization: _____________________________________________________ Name and Title of Primary Contact Person:_______________________________________________ Address: ________________________________________________________________________ City: ______________________________________ State: __________________ Zip: ___________ Telephone:(____)__________ Fax:(____)___________ Email: _______________________________ Name and e-mail of Secondary Contact Person: _________________________E-mail___________ In the lines below, provide a short project summary of the infant/mother/caregiver oral health education program. Also, underline or highlight one innovative characteristic of the education program:___________________________________________________________________________ Estimated Number of infants and mothers/caregivers involved : __________ Estimated Total Number and Type of Volunteers involved : ______________ Number of Dentists involved _______________ Past Grants Received from ADAF Harris Fund, if any (please list project titles and years): _________________________________________________________________________ Total Project Budget: $ __________ Harris Fund Grant Request: $ __________ Itemize and briefly describe how grant funds will be used—note 2009 grant funds may only be used for education materials: (Example: $ 50.00 Description of Use: language translation services) (Example: $ 150.00 Description of Use: instructional DVDs) Sum total dollars of items listed below should equal “Harris Fund Grant Request” dollar sum noted above. a. _______ Description of Use: _________________________________________________ b. _______ Description of Use: _________________________________________________ c. _______ Description of Use: _________________________________________________ d. _______ Description of Use: _________________________________________________ e. _______ Description of Use: _________________________________________________ f. _______ Description of Use: _________________________________________________ The following items are required with your proposal unless marked “optional.” Place a check mark to confirm you have included the following information with the proposal submission:
Section A (no more than 5 page narrative)
___ Information about grantee organization(s) [See page 3 for Section A requirements]

Section B
___ Bio-sketch of key project personnel ___ IRS documentation of tax exempt status (e.g., IRS determination letter or top page of IRS Form 990) ___ W-9 form ___ Letter(s) of support (optional)

The 2009 Grant Proposal Summary Form and the required information specified above including, but not limited to, the completed W-9 form and proof of non-profit status must accompany the


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proposal. The complete submission must be RECEIVED no later than January 8, 2010. The ADA Foundation is not responsible for lost or delayed applications. (Please save the Grant Proposal Summary Form [an MS Word document] to your computer, modify it and print it out to include with submission. It is available at www.adafoundation.org)

Samuel D. Harris Fund for Children’s Dental Health Grants Program

The ADA Foundation Samuel D. Harris Fund for Children’s Dental Health is a permanent endowment fund dedicated to the prevention of childhood caries and oral health promotion and education. The Harris Fund awards competitive grants of up to $5,000, to selected applicants whose oral health programs are designed to improve and maintain children’s oral health through primary prevention and education. Please note 2009 funding is more limited than in past years. A total of $50,000 will be available for program grants and approximately 8-10 awards will be made. Objectives For the 2009 program year, grant funding will be exclusively considered from organizations that sponsor programs for mothers/caregivers to help reduce the incidence of early childhood caries (ECC) in infants by increasing awareness of oral health. Funding will be offered to perinatal and postnatal programs that seek to provide oral health instruction to mothers/caregivers of infants. The 2009 program encourages synergy between dentistry, the health professional and the social service communities.

Eligibility Criteria Proposals for grants of up to $5,000 received from community-based, non-profit, oral health and early childhood caries prevention education programs for mothers/caregivers of infants in the United States and its territories that comply with the Submission Guidelines will be considered. Examples of qualified oral health promotion programs include the following:
   oral health, ECC and nutrition education materials designed for parents of infants, caregivers of and/or child care providers for infants; ECC education programs for mothers and caregivers of infants in conjunction with prenatal classes, post-partum classes, Women, Infants and Children programs and other infant preventive education and health awareness venues; and development of public service announcements (PSAs) and other mass media vehicles to increase awareness of, and appreciation for, proper infant oral care to prevent ECC.

Evaluation of Proposals The Harris Fund Advisory Committee will evaluate all responsive proposals, and grant award decisions are in the sole discretion of the ADA Foundation. For the 2009 grant year, funds may only be requested for ECC education programs for mothers/caregivers of infants. The Foundation may also conduct a site visit as part of the grant evaluation process. Proposals will be ranked and grants awarded based on the following criteria:
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the oral health awareness education and early childhood caries prevention content targeted to prenatal and postnatal education programs with preference given for originality, creativity and innovation; o a defined method for measuring impact on the target audience with preference given to programs that measure and report past metrics of success; o the potential for, or history of, continuous program operation; o demonstrated community and interprofessional involvement including volunteer support; and o the proposal information furnished under sections A and B, and the information obtained through a site visit, if any.

Submission Guidelines Submitted proposals must include the GRANT PROPOSAL SUMMARY FORM in addition to items listed in SECTION A and B below. An I.R.S. W-9 form is also required; a blank W-9 is posted in several locations on the ADAF Website, including the top of the Grants/Scholarships page and directly following this downloadable document. SECTION A Information requested in Section A must be printed on no more than five (5) pages with one-inch left and right margins. 1. 2009 version of Grant Proposal Summary Form must be used. 2. Description of project to be funded as outlined in Evaluation of Proposals section of this RFP. 3. Project budget with specific rationale on how grant funds will be utilized. In addition, please submit the following support documents listed in SECTION B. SECTION B Use additional pages as necessary for information requested in Section B (These documents may be used by the review committee, and are required to receive ADAF grants). 1. Biosketch paragraph about key project personnel (please do not submit CVs or resumes). 2. IRS documentation [e.g. determination letter or Tax Identification Number] of non-profit, taxexempt status [e.g., 501(c)(3); 501(c)(6); 509 (a)] or governmental agency status. 3. Where applicable, letter(s) of support from confirmed co-sponsors, including levels of commitment. Letter(s) of support from local and/or constituent dental society will be favorably viewed. 4. If you require notification that the ADAF received your application, please request delivery notification from the shipping service you choose. The ADA Foundation no longer confirms receipt of applications.    REQUIREMENTS – New Processes for 2009: Outdated versions of Grant Proposal Summary Forms, incomplete or late applications will not receive response or consideration. If you require confirmation of receipt of your application, please request delivery notification from the shipping service you choose. The ADA Foundation no longer confirms receipt of applications. 2009 Harris Fund grants are to be requested solely for prenatal and postnatal education of mothers/caregivers related to prevention of early childhood caries. Requests for dental supplies, dental equipment, staff or professional salaries will not be considered. Only one proposal submission per organization will be accepted. Number each page of the proposal, and type on only one side of the paper. Do not bind, staple or place in a folder.
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Do not submit additional materials such as videos or promotional gifts, because these items will not be duplicated or submitted to the grant review committees. The Harris Fund does not provide funds for indirect costs; cost recovery; capital costs (purchasing, remodeling, or furnishing of facilities); grants to individual people, or lobbying of any kind. Former recipients of a Harris Fund grant who have not submitted a Final Report will be disqualified from grant consideration until the Final Report is submitted. Proposals must be RECEIVED no later than January 8, 2010. Proposals sent via fax or email will not be considered. The Foundation discourages inclusion of a cover letter or correspondence, because it cannot be provided to the review committee. Please write all application information on the Summary Form or in Section A. Submit complete proposal to: ADA Foundation – Harris Fund 211 East Chicago Avenue Chicago, IL 60611-2616 Program Timetable - New Processes for 2009

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October 2010 - Request for proposals posted on the ADAF Website at www.adafoundation.org. January 8, 2010 - Proposals must be received no later than January 8, 2010. If you require confirmation of receipt of your application, please arrange that confirmation with your shipping vendor or U.S. Post Office. The ADA Foundation will not confirm receipt of applications. After March 2010 - list of grant recipients will be posted on www.adafoundation.org. New for 2009—the process to find out whether a grant has been awarded is to log on to www.adafoundation.org after March 2010 to view the list of grant recipients. Regrettably, due to limited grant dollars the ADAF will fund 8-10 programs in 2009. If your program is not listed on adafoundation.org as a selected grantee we encourage you to try again next year. March-April 2010 - grant recipients (only) will be notified via e-mail of the required Grant Terms. Communication is via e-mail; thus, be sure to notify ADAF (FamularoR@ada.org) if the primary contact listed on the grant application changes. Once a signed ADAF Grant Terms document is returned to ADAF, grant recipients will be sent a check in the full amount of their award. Written report(s) are due to the ADA Foundation regarding the use of the grant funds as outlined in the Grant Terms form grantees must sign.

Additional Information If you have any questions or need additional information, please contact the ADA Foundation at (312) 440-2763 or Ms Rose Famularo at famularor@ada.org. Additional information on ADAF and its programs can be found at www.adafoundation.org. Please frequently check the ADA Foundation website for program information.


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