Partnership for a Healthier Alexandria 2022 Grant Application

Pre-Application Checklist

The organization applying for Grant funding:

𝤿 is a tax-exempt 501(c)(3) nonprofit organization.

𝤿 serves individuals and families in the City of Alexandria.

𝤿 will demonstrate how Grant funds will serve City of Alexandria residents.

𝤿 will target at least one of the required strategies and related tactics outlined as priorities by the Partnership for a Healthier Alexandria Grant Program.

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* 1. Organization Information
Organizations must provide the following information to apply for the grant:

Organization Name:

Address:

Zip code:

Organization EIN (Organizations must have 501(c)3 status or a fiscal agent/sponsor that has 501(c)3 status to be eligible to receive a grant)

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* 2. Primary contact for grant correspondence

Name:

Job Title:

Email address:

Phone number:

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* 3. Authorized representative, if different from primary contact

Name:

Job Title:

Email address:

Phone number:

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* 4. Please provide a brief description of the organization. The response needs to include who the organization serves and the types of programs and services offered. (The description should be between 300-450 words.)

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* 5. Please identify the specific priority area and strategy your proposed initiative/effort will focus on.

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* 6. Please identify the specific tactic or tactics, under the strategy you selected in question 5, your proposed initiative/effort will focus on. Please type N/A if you are proposing a new and innovative tactic and respond to question #7.

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* 7. If you are proposing a new and innovative tactic that is not under the strategy you selected, please provide (1) a brief description of this tactic and the direct connection between this tactic and its contribution to achieving the selected strategy and (2) identify if this tactic is a best practice or a promising practice and if it is, briefly describe the support for the classification.

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* 8. Please describe in no more that 700 words:

Purpose of your grant initiative/effort,

How the initiative/effort will be implemented, and

Any potential challenges that might arise and plans to address them.

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* 9. Please describe in no more than 200 words the anticipated timeline for the initiative/effort’s implementation.

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* 10. Please describe in no more than 300 words how this initiative/effort promotes racial equity or addresses inequities or disparities in Alexandria.

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* 11. In one to two paragraphs, describe how the impact of this initiative/effort will be defined and measured if this grant is awarded. Please be as specific as possible about the short- medium- and/or long-term outcomes for the proposed initiative/effort. (The description should be between 300-450 words.)

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* 12. Budget Information: Please describe the total grant amount requested, including all major budget items (any budget item that is at least 5% of the total requested funding) and brief description (up to one sentence) for each applicable item. Also, please identify items specifically related to staff/personnel costs and those specifically related to non-staff/personnel costs.

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* 13. Commitment

By checking the acknowledgment and acceptance of terms box below, the person authorized to submit this grant application agrees to the following:

To acknowledge the Partnership for a Healthier Alexandria’s support in any planned media coverage, press releases, or publications regarding this initiative/effort by indicating “This event/message/activity is funded by a grant from the Partnership for a Healthier Alexandria.”

To use the grant funding as proposed in this application.

To expend no grant funding beyond September 30, 2023.

To submit the required final report no later than October 30, 2023, using the template to be provided by the Partnership for a Healthier Alexandria.

Unused funds must be returned to the Partnership for a Healthier Alexandria by October 30 2023.

I acknowledge and accept these terms.

Partnership for a Healthier Alexandria 2022 Grant Application

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* 1. Organization InformationOrganizations must provide the following information to apply for the grant:

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* 2. Primary contact for grant correspondence

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* 3. Authorized representative, if different from primary contact

Question Title

* 4. Please provide a brief description of the organization. The response needs to include who the organization serves and the types of programs and services offered. (The description should be between 300-450 words.)

Question Title

* 5. Please identify the specific priority area and strategy your proposed initiative/effort will focus on.

Question Title

* 6. Please identify the specific tactic or tactics, under the strategy you selected in question 5, your proposed initiative/effort will focus on. Please type N/A if you are proposing a new and innovative tactic and respond to question #7.

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* 8. Please describe in no more that 700 words: Purpose of your grant initiative/effort, How the initiative/effort will be implemented, and Any potential challenges that might arise and plans to address them.

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* 9. Please describe in no more than 200 words the anticipated timeline for the initiative/effort’s implementation.

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* 10. Please describe in no more than 300 words how this initiative/effort promotes racial equity or addresses inequities or disparities in Alexandria.

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* 1. Organization Information
Organizations must provide the following information to apply for the grant:

* 8. Please describe in no more that 700 words:

Purpose of your grant initiative/effort,

How the initiative/effort will be implemented, and

Any potential challenges that might arise and plans to address them.