Kansas Health Foundation

 

 

 

Recognition Grant Application Form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Kansas Health Foundation is a philanthropic organization dedicated to improving the health

of all Kansans. Each year the Foundation pays out approximately $20 million in grants to non-profit organizations throughout the state in the areas of public health, children’s health and leadership.

 

Kansas Health Foundation

Recognition Grants

 

 

WHAT ARE RECOGNITION GRANTS?

 

Recognition Grants are grants of up to $25,000 made to grassroots non-profits and government entities doing innovative and meaningful work that fits within the Kansas Health Foundation’s mission to improve the health of all Kansans. Recognition Grants expand the Foundation’s support to a broad range of health-related organizations throughout the state. The Foundation awards up to $750,000 annually in two cycles per year using a competitive application process.

 

The Recognition Grants Program is highly competitive, because a limited amount of funding is available each year. As with any competitive process, the grants are awarded to the best among a pool of extraordinarily good applicants. The Foundation regrets that funds are not available to recognize the meaningful work of all who apply.

 

WHEN IS THE DEADLINE?

 

Application deadlines are March 15 and September 15 each year. Grant announcements are mailed by the Foundation within approximately 60 days following the application deadline.

 

WHO IS ELIGIBLE?

 

Any tax-exempt, non-profit organization or government entity using the funds for charitable purposes and proposing a project meeting the Foundation’s mission to improve the health of all Kansans is eligible to apply. Specifically, applications should meet the criteria shown below.

 

WHAT ARE THE CRITERIA?

 

Projects must meet the Foundation’s mission to improve the health of all Kansans. In addition, the organization must be:

1.      Classified as tax-exempt under section 501(c)(3) of the U.S. Internal Revenue Service Code, or a governmental entity

2.      Located within the state

3.      Not a previous recipient of a Recognition Grant within the calendar year

 

Projects are selected based on:

·        Focus on prevention (to what degree does it prevent high-risk health behaviors?)

·        Meeting a clear, identifiable need

·        Creativity

·        Operational strength of the applicant organization, including project leadership

·        Ranking when compared with other applications received during the funding cycle

 

FUNDING LIMITATIONS

 

Funding will not be provided to support the following:

·        Clinical or medical research

·        Contributions to capital campaigns

·        Organizations that practice discrimination by race, color, creed, sex, age or national origin

·        Operating deficits or retirement of debt

·        Endowment programs

·        Construction projects or real estate acquisitions

·        Political projects of any kind

·        Vehicles, such as vans or buses, or emergency medical services equipment

 

DEADLINES/RESTRICTIONS

 

·        The Kansas Health Foundation does not provide funding to Private Foundations.

·        We will not accept copies of the IRS application for non-profit status.  We must have a copy of the current IRS Determination Letter.

·        Your organization will be verified through the Secretary of State’s Business Entity Search.   Please feel free to check your organization’s status with the Secretary of State at the following web site prior to submitting your application:  www.kssos.org.  We will not accept applications from organizations not “active and in good standing” with the Secretary of State.

·        Grants are for amounts up to $25,000.  The Foundation wants to support as many programs across the state as possible; therefore, smaller requests are encouraged.

·        Application deadlines are March 15 and September 15 each year.

·        All materials must in the offices of the Kansas Health Foundation by 5 p.m. on the due date. When the 15th falls on a weekend or holiday, applications are due by

      5 p.m. the next working day.

·        Please do not send more information than is requested.

·        All deadlines will be strictly adhered to.

·        Incomplete/incorrect/unsigned applications will be returned.

·        No faxed or e-mailed copies will be accepted.

·        Grant announcements will be mailed within approximately 60 days after the deadline.

·        Grant recipients are selected by an independent panel of reviewers from across the state.

·        Due to volume of applications, the Foundation does not provide an oral or written explanation for denied applications.

 

HOW DOES YOUR ORGANIZATION APPLY?

 

Complete this application form (including signature and budget information).

Attach required documents and mail to:

RECOGNITION GRANTS

KANSAS HEALTH FOUNDATION

309 EAST DOUGLAS

WICHITA, KS 67202

If you have questions, please call the Foundation at (316) 262-7676 or (800) 373-7681.

 

For office use only

Date Received:                                                               Grant Number:                                               

 

APPLICANT ORGANIZATION INFORMATION

 

Please type.  Content and available space must not be altered.

 

Tax-Exempt Applicant Organization Name: Lawrence-Douglas County Fire & Medical Department               

                                                                          (Must be name of tax exempt organization)

Applicant Organization is:                                                             501(c)(3) organization – Current IRS tax status letter must be included

                                                                      (Applicant Organization name must be exactly as shown on the 501(c)(3) letter)

x Government entity

   Church – are you part of an IRS Group Ruling?

         Yes (include copy of Group Ruling Letter)

         No (application must be signed by an authorized representative of the Church)

           

Applicant Organization Street Address: 1911 Stewart                                                                                      

City: Lawrence                           County: Douglas                      State: KS         Zip: 66049                               

Phone: 785-423-3699                                         Ext.:            Fax: 785-832-7607                              

Organization E-mail:                                                  Web site:                                                   

Organization’s President/Executive Director: Chief Mark Bradford                Title: Fire Chief                 

What is the Mission/Purpose of Applicant Organization? Commented Saving and Protecting Lives and Property

 

Have you ever received Recognition Grant funding?   Yes  X No  If yes, when:                                         

 

Your application will be considered complete if you include the following documents:

(incomplete/incorrect applications will be returned)

 

Original and six copies (collated, stapled, and unfolded) of:

 

        Four-page application form signed by an authorized signator, including:

  Applicant Organization Information (Page 1)

  Project Information (Page 2)

  Project Description (Page 3)

  Budget Narrative (Page 4)

        List of Board Members (Board of Directors, Board of Regents, Board of Education, etc., as applicable to the applicant organization)

        Current Internal Revenue Service 501(c)(3) tax status determination letter in the name of the applicant organization shown above, if applicable

 

To the best of my knowledge and belief, our status as a tax exempt organization is current and in good standing with the Internal Revenue Service.  I certify that I am authorized to sign as fiscal agent for entity shown above:

 

Name:                                                                                 Title:                                           

                                       (Please print)

 

Signature:                                                                                 Date:                                                  

                                    (Authorized Signature)

 

 

PROJECT INFORMATION

 

Project Title: Operation Kindergartner                                                                                                                                         

Project Director/Contact Person: Rob Kort                                                                                                                                    

Position/Title: Division Chief                                            Organization: Lawrence-Douglas County Fire & Medical         

Street Address: 1911 Stewart                                                                                                                                                                          

City: Lawrence                                                                                                       State: Kansas        Zip: 66046                        

Phone: 785-423-3699                          Ext.:                                   Fax: 785-832-7607                                                               

Project Director/Contact Person E-mail: rkort@ci.lawrence.ks.us                                                                                           

Project Duration: 9 months                                  Start Date: 9/1/2006                      End Date: 5/1/2007                               

County(ies) served by this project: Douglas County                                                                                                                   

Target Population of the project (include number served): 1700 kindergartners                                                                 

PROJECT QUESTIONAIRE

 

Please keep answers limited to the space below. Applications that go over the space allotted will not be considered. Additional details can be provided in the “Project Description on page 3.”

 

1.       What is the project mission? Provide bicycle education and helmets for every kindergartner in Douglas County.  This would include the cities of Lawrence, Eudora, Baldwin, Lecompton, all private schools and all home school students.

 

2.    What health problems or need of the target population does this project address? Why should it be addressed?

       60 % of head injuries and death from wheeled sports are children under the age of  16.   88% of these injuries could be prevented with the use of a helmet.  Less than 18% of the children in this age group wear a helmet.  We need to make wearing a helmet cool.  The way to do this is start with these young children and make sure they all have one.  Then the peer pressure will be to wear a helmet, rather than not wear a helmet.

3.        What will be the anticipated health improvements in the target population as a result of this project? Please be precise about the expected impact of this project. 

If we increase the number of children that wear helmets, then we will decrease the number of children that receive a head injury or that die from a head injury.  In Canada in 2003 all bicycles fatalities were not wearing a helmet.

 

PROJECT BUDGET

 

Budget Beginning Date: 9/1/2006                                              Budget Ending Date: 6/1/2007                                           

TOTAL COST OF THIS PROJECT                                                                                                           $                          

AMOUNT REQUESTED FROM KANSAS HEALTH FOUNDATION:                 $ 19,900.00             
LIMITED TO A MAXIMUM OF $25,000.00


KANSAS HEALTH FOUNDATION BUDGET

            HOW WILL KHF FUNDS BE SPENT? PLEASE PROVIDE DETAILS BELOW:

                        Personnel (existing)                                                                                         $ 4,500.00                

                                Fringe benefits (maximum 25% of salary)                                           $ 000                          

                        Personnel (new)                                                                                               $ 000                          

                                Fringe benefits (maximum 25% of salary)                                           $ 000                          

                        Consultant                                                                                                        $ 000                          

                        Equipment                                                                                                         $ 000                          

                        Supplies                                                                                                             $ 1800.00                 

                        Travel                                                                                                                 $ 000                          

                        Indirects (maximum 10% of salaries and fringe)                                      $ 000                          

                        Other                                                                                                                 

                                1,700 bicycle helmets                                                                               $ 13,600                   

                                                                                                                                             $                          

                                (Please attach additional sheet if necessary)                                     

TOTAL (should match amount requested from KHF above):                $ 19,900.00                           


 

PROJECT DESCRIPTION

 

Outline what you plan to accomplish (objectives) and how you propose to achieve the objectives.  Please limit to one page.

 

Lawrence-Douglas County Fire & Medical Department (LDCFM) will implement operation Kindergartner.  LDCFM currently conducts two other programs in the school district.  Operation Kindergartner would operate in the same fashion.  Firefighters would conduct helmet safety programs in each classroom.  Providing an interactive program to the students.  During the program the students will learn why it is important to wear a helmet, and what could happen if they choose not to wear one.  At the end of the program each student would be fitted with a bicycle helmet.  During the fitting process the teachers would also learn how to fit a helmet so he/she would be able to monitor proper fit in the future.

 

Operation Kindergartner will provide every kindergartner in Douglas County with a bicycle helmet.  This will allow wearing a helmet to be “cool” as no one would be left out.  These children will form a habit in wearing a helmet that will carry on as they become older.  The problem with older children wearing helmets is they feel more as an outcast when they wear a helmet, due the vast majority of children do not wear helmets.  This will change with the kindergarten class of 2007. 

 

This concept is similar to wearing a seat belt.  Children now grow up wearing a seatbelt and do not think about not wearing one.  We must reach the same point with bicycle helmets.

 

BUDGET NARRATIVE

 

Explain budgeted items and how each contributes to the project.  If new personnel are budgeted, please describe plans for financial sustainability.  Please limit to one page.

 

     The personnel cost is portion of what the overtime cost will be to call back Firefighters to send them into the schools to conduct the helmet education and fitting of the helmets.  The Fire & Medical department will cover the remaining personnel cost.  The supplies will be the written material that each student will receive on the helmet education.   This material will include a coloring book of children wearing helmets while enjoying wheeled sports.  These sports will include bicycle riding, skateboarding, rollerblading, and riding a scooter.  There will also be information regarding fitting a helmet and the importance of wearing a helmet for the parents.  We need to educate the parents to re-enforce wearing a helmet every time their child participates in a wheeled sport.

 

The last cost of this program is the actual cost of the helmets.  Our current cost for the helmets we provide children who come to a fire station is  $ 8.00 per helmet.  We stock five different colors to provide a choice to the children.  Again if the child does not feel the helmet is “cool looking” they will not wear it.  It is estimated we will need 1700 helmets for all the kindergartners in Douglas County.