Johnson & Johnson Community Health Care Program
Application for 2013 - 2016 Funding Cycle
Deadline: May 15, 2013 - 5:00 p.m. (EST).
The following sections are required to complete your proposal:
- An abstract
- A description of your organization
- A proposal narrative (goal, objectives, implementation and evaluation plan)
- Budget form and plan for sustainability
The following Support Letters are required in your proposal and should be faxed to 410-510-1974:
- Include a Letter of Support (from the CEO or Board Chair).
- If applicable include letters endorsing community and other organizational collaborations.
- Include a copy of your 501(c)3 IRS letter to verify your organization’s tax-exempt status.
PLEASE REVIEW THE FOLLOWING GUIDELINES
(250 words max.)
Describe the target population. Describe organizational capacity and staff skills relevant to childhood obesity prevention education interventions. Summarize the expected outcomes. Mention whether this proposal is an outgrowth of existing programs or a new initiative.
II. Organizational Information (10 points)
(1500 words max.)
Please describe the following:
- Tell us about your organization, relevant personnel and available resources;
- The proposal’s target population;
- Length of time that your organization has served this population;
- The qualifications and demonstrated relevant skills of your implementation team:
Biographical paragraphs for the Program Director and other relevant staff on the proposal. Please include their academic background, appropriate experience relevant to community-based childhood obesity prevention interventions and past experience working with this population.
- Any collaborations that your organization has as they relate to childhood obesity prevention interventions.
- Describe how your organization has shared the results of other programs, including any conference presentations by staff related to this proposal.
- Any awards or recognition your organization has received from the community or for service to the community.
III. Proposal Narrative (65 points total)
- Needs Assessment (10 points)
(500 words max.)
Describe the extent of the childhood obesity problem among your target population, including information sources used to identify this health need. Provide local demographic data on sex, ethnicity, education and household incomes. Include national or state data to provide a context. If this proposal builds on an existing initiative, please describe the accomplishments to date. If this proposal is a new initiative, please describe any feasibility assessments that have been done to date.
- Program Goals And Objectives (5 points)
(500 words max.). Provide a clear goal, objectives (that are specific, measurable, achievable, relevant, time-bound), and valid indicators grounded on evidence based practices.
- Program Plan - Operationalizing Your Program Goal And Objectives (30 points)
(2000 words max., inclusive of timeline)
Describe the program you would like to implement if successfully funded. List/quote the evidence-based approach(es) you plan to adapt during the Formative Phase in preparation for Implementation. Describe how you will reach your target population including recruitment and retention strategies. Please note if incentives will be used. List planned activities for each program objective Must include timelines for all program activities (You may use the attached timeline as a guide.) Identify personnel responsible for each activity. Identify any partners, collaborating institutions or community groups, and describe their commitment to the goal and objectives of this project.
- Evaluation (20 points)
(500 words max.)
Provide a general evaluation plan to assess your program’s effectiveness in achieving specific goal and objectives. Anticipate outcome measures for each of your objectives. Estimate the total number of direct and indirect beneficiaries that will be reached. Describe your organization’s capacity and commitment to participate on the hands-on training in evaluation design and implementation in collaboration with Johns Hopkins doctoral student and faculty mentor and supervisor. (Please refer to the J&J CHC Scholar’s Program link for more information.)
IV. Budget Justification and Plan for Sustainability (15 points)
Note: We do not support indirect costs.
Total operational budget for your organization
You must provide all of the following information for your proposal to be considered for review:
- Provide the total dollar amount of the operational budget for your entire organization.
- If funded, what percentage will this J&J-funded program represent of your organization’s total operational budget?
- Identify the funding sources currently supporting your existing program activities. If these existing funds will be blended or shared with this grant, letters of support (memoranda of understanding are acceptable) from those funding institutions should be included indicating their level of support for this proposed project.
- Please use our attached Budget Template and name the document budget.xls. The following three required budgets are to be incorporated into one Excel Document:
- Proposed budget for Formative Phase: $60,000:
October 1, 2013 –May 31, 2014
(250 words max.)
Include detailed budget requirements. Costs must be directly related to the development of the J&J CHC Program funded intervention, as follows:
- Personnel time allotted to the Formative Phase process, including evaluation point person
- Review and revision of program components, including goal, objectives, indicators and timelines.
- Development and design (in close collaboration with the Johns Hopkins TA team) of an evaluation plan.
- Development of evaluation tools and database creation.
- Development and design of materials needed for the intervention.
- Expenses directly related to the implementation of at least one pilot.
- Proposed budget for Implementation and Communication Phases: (Total 500 words max.: 250 words for each one of the implementation phases):
Ø Implementation Phase-Part 1: $ 70,000: June 1, 2014 – March 31, 2015
Ø Implementation Phase-Part 2 & Dissemination Phase: $70,000:
Ø Must include detailed budget requirements. Costs must be directly related to the development of the J&J CHC Program funded intervention, as follows:
- Direct program expenses, including personnel expenses and costs associated with implementing the intervention.
- Costs associated with staff time for data entry using newly created database.
- Participant recruitment and incentives.
- Costs associated with staff time for: data analysis, data presentation and report writing.
- Administrative expenses directly related to the intervention activities. (Note that the J&J CHC Program does not fund administrative expenses exceeding 15% if the total program budget).
(250 words max.)
Explain how this grant will help your organization obtain continuing funding for the program beyond this grant.
Other required documentation: (Use our Fax Coversheet for all fax transmittals)
V. CEO Letter of Support
Please click "Submit" once you have faxed us a signed letter of support from your CEO or Board Chair. All letters must be on organization’s letterhead and show original signatures. Please fax to 410-510-1974 using the attached fax coversheet.
VI. Collaborating or Endorsing Letters of Support
Please click "Submit" once you have faxed us signed letters of support from your collaborating partner(s) and/or endorsing persons/institutions. (Please send no more than two letters of endorsement). All letters must be on organization’s letterhead and show original signatures. Please fax to 410-510-1974 using the attached fax coversheet.
VII. 501(C) 3
Please click "Submit" once you have faxed us a copy of the IRS letter that verifies your organization's tax-exempt status. Review our Helps/Guidelines page for specific questions regarding this documentation. Please fax to 410-510-1974 using the attached fax coversheet.
Overall Assessment (10 points)
This section is for the proposal reviewers’ assessment only and cannot be modified by the applicant.
- This application is set to automatically log you out after 30 minutes of "inactivity," so be sure to "Submit" your work periodically.
- Applications will ONLY be accepted online, not via U.S. mail, facsimile or as an e-mail attachment.
- Your information is neither entered into our database, nor considered complete until you click the "SUBMIT FINAL APPLICATION" button. This button will appear only after all boxes on the application have been checked off.
- Once you have completed a final submit of your application, you should receive the message, "We have received your application.
- Sierra Veale, Administrative Coordinator, Johns Hopkins Community Health Care Program, will contact you within the next few days if any part of your application appears missing or incomplete. For questions regarding your application, please call Sierra Veale at (443) 287-5138.
- Implementation Phase 2: April 1, 2015 – January 31, 2016 , and
- Dissemination Phase: February 1, 2016 – March 31, 2016.