REQUEST FOR PROPOSAL (RFP)
Grant applications now being accepted for BREAST HEALTH AND/OR BREAST CANCER EDUCATION AND SPECIAL PROJECTS
The mission of Susan G. Komen for the Cure is to save lives and end breast cancer forever by empowering people, ensuring quality care for all and energizing science to find the cures. Affiliates of Komen represent one of the nation’s largest private funding sources for breast health and breast cancer screening, education, and treatment support programs. Susan G. Komen for the Cure – South Florida Affiliate is currently accepting applications for grants. Innovative projects in the area of breast health, breast cancer education, and outreach will be considered. Special projects targeting services not otherwise available to the medically underserved populations will also be considered. Grants must address the needs of residents of Palm Beach, Martin and St. Lucie Counties. Grants are available for up to one (1) year. The current grant cycle runs from April 1, 2009 through March 31, 2010.
Important Note
Applications will be accepted for any breast health or breast cancer screening, education, or support project in the listed counties. However, projects that specifically address the objectives outlined in the “Statement of Need” will be given priority. All requests for science research funding should be directed to the Susan G. Komen for the Cure Award and Research Grant Program in Dallas, Texas. More information on research funding is available at www.komen.org/grants.
APPLICATION DEADLINE IS 1:00 PM ON FRIDAY, NOVEMBER 28, 2008. APPLICATIONS RECEIVED VIA U.S. MAIL MUST BE POSTMARKED BY NOVEMBER 26, 2008 TO BE ACCEPTED.
STATEMENT OF NEED: Through a community needs assessment, the South Florida Affiliate of Susan
G. Komen for the Cure has identified the following: Projects that focus on Komen’s mission/promise “ to save lives and end breast cancer forever by empowering people, ensuring quality care for all and energizing science to find the cures.”
Susan G. Komen for the Cure 2008 Update
1
GUIDELINES AND INSTRUCTIONS FOR APPLICANTS
The purpose of this program is to address the breast health and breast cancer education needs of Palm Beach, Martin and St. Lucie Counties.
QUALIFICATIONS: Applications are accepted from U.S. non-profit institutions; U.S. citizenship or
residency is not required. Applications must be submitted in English. Applicant organizations must be providing services to residents of Palm Beach, Martin and/or St. Lucie Counties.
RESTRICTIONS:
− − − − Project must be specific to breast health and/or breast cancer; e.g. if a project is a combined breast and cervical cancer project, funding may only be requested for the breast cancer portion. Applicants must be U.S. non-profit (federally tax-exempt) organizations, educational institutions, government agencies, and/or Indian tribes. Services must be provided to residents of Palm Beach, Martin and/or St. Lucie Counties. Salaries, if requested, are for personnel related to this project only and not the general work of the employee.
Failure to adhere to the RFP guidelines will result in the RFP being deemed OUT OF COMPLIANCE AND THUS WILL NOT BE FORWARDED FOR REVIEW.
REVIEW: Applications received complete, and in compliance with these guidelines, will be submitted
for grant review by a panel established through the local grants committee.
EDUCATION MATERIALS: A variety of education materials are available from Susan G. Komen for
the Cure. Some items are targeted to special populations. Before requesting funds to purchase items from other sources or create new materials, please contact the Susan G. Komen for the Cure – South Florida at cost. We expect that Komen materials be used in the project whenever possible.
CONTRACTS: A grant contract will be the legal mechanism for funding. GRANT PERIOD: Grant period begins April 1, 2009 and will conclude on March 31, 2010.
PAYMENT AND REPORTING:
1. The first payment, (50% of grant award), will be made no later than thirty (30) days after receipt of the fully executed contract. All Grantee’s will be required to submit quarterly reports 2. Upon receipt of satisfactory 2nd quarter report, (due October 7, 2009), the second payment (25% of grant award), will be made.
Susan G. Komen for the Cure 2008 Update
2
3. The final report is due within twenty-one (21) days of completion of the grant period. 4. The final payment of 25% of grant award will be made upon receipt of satisfactory final report, due April 21, 2010. An electronic version in Word (no PDF will be accepted) of this report is required along with a signed hard copy.
LETTERS OF SUPPORT AND ADDITIONAL MATERIALS: DO NOT send additional materials (i.e.
reprints, complete curriculum vitae or letters of support). These will be discarded.
CONFIRMATION OF RECEIPT OF APPLICATION: Confirmation of receipt of application will be mailed
to the Project Director following review for compliance. If immediate confirmation of receipt is requested, please include a self-addressed, stamped postcard that will be returned to you immediately upon receipt of the application. Please do not contact the South Florida Affiliate of Susan G. Komen for the Cure regarding the status of the application during the review period.
ANNOUNCEMENT: Announcement of grants awarded will be made in March 2009. Project Directors
will be notified of the outcome of the review in writing.
NUMBER OF GRANTS TO BE AWARDED: The actual number of awards will depend on the amount
raised as well as the funding granted per project. Awards and funding are at the sole discretion of the Board of Directors of the South Florida Affiliate of Susan G. Komen for the Cure.
GRANTEE RESPONSIBILITY: Grantee (Project Director or representative) agrees to attend the 2009
grant’s breakfast/luncheon, 2009 Race sponsor reception, 2010 Race for the Cure, and/or 2009 Komen National Meeting if requested. Failure to do so will strongly impact future funding of this program/project.
Susan G. Komen for the Cure 2008 Update
3
APPLICATIONS SHOULD INCLUDE AND BE ORDERED AS FOLLOWS:
A. Cover Page (form attached) Note: Signature of approving institutional personnel, other than Project Director, required (e.g. President of Board, CEO, Executive Director, etc.). B. Abstract Page (form attached) C. Project Description (This section should not exceed five (5) typewritten pages. Font size should be twelve-point. Please use boldface headings, preferably bullet points or numbers instead of narrative, for each of the following topics: 1. Brief explanation of project. 2. Statement of need/problem to be addressed. 3. Description of constituency to be served and how they will be benefited (please indicate target number of women or men to be served). 4. Description of program goals and measurable objectives. 5. Description of activities planned to accomplish these goals. Is this a new or ongoing activity of your hospital or organization? 6. Timetable for accomplishing goals. (Please note: quarterly reports are required). 7. Long-term sources/strategies for funding of the program after initial funding. 8. Description of other organizations or entities, if any, participating in the program. If applicable, letters of collaboration should be included from each organization. 9. An explanation of how this program is unique from other comparable programs offered in this service area. D. Financial Information (Not to exceed three (3) typewritten pages). 1. Budget for requested funds (form attached). 2. Budget Justification and Detail. 3. List of sources of funding for the project. 4. List additional sources of funding to continue the program should Komen funds be depleted before conclusion of grant cycle. E. Payment Form (attached) (“If awarded grant, the check will be payable to …”). F. Biosketch Form (attached) for project director and attendant personnel listed in budget request. G. Proof of non-profit status for applicant institution. H. Most Recent Progress Report: Previous grantees of the South Florida Affiliate of Susan G. Komen for the Cure must attach their six-month or final report for their most recent grant. I. One (1) original (please indicate as such), PLUS 15 copies of each application. Each copy must be clipped (not stapled and not spiral bound) and printed on white paper. The Grant Application should be typed in 12-point font, using boldface headings. J. RFP hard copy must also be submitted in MS Word with signature and electronically
as an e-mail attachment to: tina@komensouthflorida.org K. Final Check List must be included (form attached).
Susan G. Komen for the Cure 2008 Update
4
COVER PAGE FOR GRANT PROPOSAL
REQUEST FOR FUNDING FOR BREAST HEALTH AND/OR BREAST CANCER EDUCATION/SPECIAL PROJECTS PROJECT DIRECTOR & TITLE ORGANIZATION/INSTITUTION ADDRESS
PHONE ( FAX ( E-MAIL
) )
TITLE OF PROJECT ______________________________________________ TOTAL AMOUNT REQUESTED GRANT PERIOD APPROVING CEO / EXECUTIVE DIRECTOR/ PRES. OF ORGANIZATION SIGNATURE NAME & TITLE OF APPROVING INSTITUTIONAL PERSONNEL PLEASE CHECK TYPE OF APPLICATION TYPED EDUCATION/OUTREACH SPECIAL PROJECT DATE April 1, 2009 to March 31, 2010
APPLICATIONS MUST BE RECEIVED BY 1 PM, FRIDAY NOVEMBER 28, 2008.
(Photocopies of this form are acceptable)
Susan G. Komen for the Cure 2008 Update
5
ABSTRACT PAGE
PROJECT DIRECTOR ORGANIZATION/INSTITUTION BCCCEDP PROVIDER? TARGET POPULATION YES NO
ABSTRACT
In the space below, please provide a short abstract, not to exceed 200 words, written in lay terms for release to the general public should this application be chosen for funding. Target population, age group target, and geographic area served must be included.
Permission to publish: Permission is granted to Susan G. Komen for the Cure, Inc. to publish the above abstract should this application be selected for funding. SIGNATURE OF PROJECT DIRECTOR NAME (TYPED) SIGNATURE OF CEO/DIRECTOR/ PRESIDENT OF ORGANIZATION NAME (TYPED) DATE
Susan G. Komen for the Cure 2008 Update
Phone Number
6
BUDGET FORM
GRANT APPLICATION REQUIRED BUDGET FORM
NAME OF PERSONNEL ON PROJECT ROLE ON PROJECT SALARY % TIME ON PROJECT SALARY
BILLED TO PROJECT
SUBTOTALS SUPPLIES (ITEMIZE BY CATEGORY)
EQUIPMENT (NOT TO EXCEED 30% OF DIRECT COST) *
TRAVEL (GOV’T. MILEAGE REIMBURSEMENT RATE/COACH AIR TRAVEL ONLY)
OTHER EXPENSES (ITEMIZED BY CATEGORY)
SUBTOTAL DIRECT COSTS
INDIRECT ALLOCATION
TOTAL FUNDING REQUEST
* Cell phones/cell phone expenses will not be covered
BUDGET JUSTIFICATION REQUIRED – PLEASE ATTACH
Susan G. Komen for the Cure 2008 Update
7
COMMUNITY EDUCATION/ OUTREACH OR SPECIAL PROJECTS
April 1, 2009 through March 31, 2010
P AYMENT S HEET
If you are awarded a grant from the South Florida Affiliate of Susan G. Komen for the Cure, the check will be made out to:
Organization/ Institution____________________________________________________
Address ________________________________________________________________ ________________________________________________________________________ City, State, and ZIP_______________________________________________________
ATTN: __________________________________________________________________ (Name & Title)
Phone _____________________________
Fax_______________________________
E-mail______________________________
Susan G. Komen for the Cure 2008 Update
8
SAMPLE BIOSKETCH FORM
PROJECT DIRECTOR (Last Name, First, Middle)
BIOGRAPHICAL INFORMATION
Information should be submitted for the Project Director and other personnel included in budget request. Please use a separate form for each person.
NAME EDUCATION
TITLE INSTITUTION
(Indicate Location)
(Begin with most advanced professional education and degree if applicable
DEGREE
YEAR CONFERRED
MAJOR
PROFESSIONAL EXPERIENCE: Please list starting with present position, employment, experience and honors. DO NOT EXCEED TWO PAGES
Susan G. Komen for the Cure 2008 Update
9
COMPLIANCE CHECKLIST
Grant clearly states and meets need(s) of Community Profile Cover Abstract Page Project Description Budget Form Budget Justification Grant Payment Sheet Progress Report, if applicable Proof of Tax-Exempt Status Bio Sketches included and limited to 2 pages each CD enclosed or e-mail attachment version sent Signature of Project Director Signature of Approving CEO/Pres. or Exec Director Original, plus 15 copies
APPLICATION DEADLINE IS 1:00 PM ON FRIDAY, NOVEMBER 28, 2008. APPLICATIONS RECEIVED VIA U.S. MAIL MUST BE POSTMARKED BY NOVEMBER 26, 2008 TO BE ACCEPTED. Submit to: Susan G. Komen for the Cure - South Florida Affiliate At Good Samaritan Medical Center 1309 N. Flagler Drive, 5th Floor West Palm Beach, FL 33401
Susan G. Komen for the Cure 2008 Update
10