Please complete the following information for your organization or partnership.

Complete information for every partner that will be financially supported with this grant.

You may propose multiple different projects in different program areas. If you do so, be sure to address each project and program area you are applying for under each of the seven questions. Please see the FAQs for examples of what this might look like. Our intention is to make this application as easy as possible to complete.

Clear and concise answers are welcome. There are no maximum or minimum word or page counts; use the amount of space you need to describe your project and answer the questions.

You can describe your project as a narrative or provide a formal work plan, whichever works best for you. (Please either attach to this Application Form or provide a work plan narrative below).

Please complete a line-item budget and high level justification using the downloadable template. Be sure to include, if needed:

• • Resources for capacity building to strengthen organizational infrastructure, fiscal and human resources management in addition to program implementation.
• • Funds for staff to participate in the learning community (assume one meeting per month, with ability to attend virtually) (applies only to applicants proposing projects for Commercial Tobacco Prevention).
• • Costs for staff time. We encourage payment of a living wage (at least $15 per hour) and a cost-of-living adjustment for year 2.
• • Funding for telephone, computer, financial equipment, purchase of new commercial general liability insurance (if applicable) needed for the work (include these in your startup costs).
• • Budget, if needed, for food, child care for community conversations, contractor/facilitator, advertising for social media, gift cards for community members to participate, etc.

You can propose multiple projects in different program areas for funding. If you do, you may submit one combined budget showing all projects, or you may submit separate budget tabs or worksheets for each project you are proposing. If you want to use one budget worksheet for projects across multiple program areas, we ask that you indicate the total funding you are requesting for each program in section (11) of the template.

We have included several options for how you can submit your requested budget. Some of these options are new. Please use whichever option works best for you for your proposed project(s).

In the future, funding may become available during emergency response and other time-sensitive opportunities for one or more of the following activities. These activities would go beyond those described in the Environmental Health, Communicable Disease Control, and Emergency Preparedness and Response section. These activities would not be performed until funds are available, but are provided as examples:

• • Engage community on emerging health priorities (for example, communicable disease outbreak).
• • Create and lead culturally specific education and awareness campaigns for emerging health priorities.
• • Support planning and implementation of culturally specific prevention activities for emerging health priorities.
• • Support policy development and advocacy for emerging health priorities.
• • Support implementation and linkage to programs to help community members manage chronic diseases such as diabetes, heart disease, arthritis and cancer.