Grants for Healthy Kansans
The following form indicates the kinds of information we require to be able to evaluate a Letter of Intent for grant funding. In some cases we may require more information and will contact the applicant.
When filling out the online form, all information will be visible on screen as one long document. The form is designed to be simple and straightforward to use. Therefore, only one section at a time will be active for editing. When you save changes in a section, the form will automatically activate the next section for you. You may follow this process straight through the form, or you may edit sections in any order you wish by clicking an edit link under the section heading.
In the sample form below, the second section, "Applicant Organization Information" is active for editing and therefore highlighted in yellow. All inactive sections are highlighted in teal. This sample form is not "live" so it will not respond to button clicks as the real form would.
Using the login name and password you select on first login, you may return to work on your Letter of Intent over as many sessions as you wish. If you have questions about how to respond to the application form, please contact a Health Fund program officer. If you are experiencing technical problems with using the online form, contact Jeff Gamber at 620-662-8586 or email through our contact page. The following is a sample only; please use the real online form if you wish to submit a Letter of Intent.
Instructions: Please fill out the requested information in each section of the form below. Only one section may be edited at a time. After completing a section, click the "Save Changes and Continue" button to save your entries and continue to the next section.
If you wish to jump directly to a different section and edit it, click the "Edit this section" link for the section you want to work on. Important--be sure to save any changes you have made to the current section before jumping to another section.
Saved information will be held until you are ready to submit the Letter of Intent. You may continue work on your request at any time by logging in again. When you are finished with your Letter, click the "Check Over" link below and follow the submission instructions on that page.
Check over and submit Grant Request(click this link after you finish entering information below)Last updated: Wed. Jan. 9th, 2008 9:00 AM
Project Basics (Short Answer)
| Project Title: | My Grant Project |
| Focus area: | Healthy Lifestyles |
| Amount of request: ($) | 0 |
| Projected Total Project Cost: ($) | 0 |
| Project Duration: | Anticipated Start Date |
| Anticipated End Date | |
| Geographic area served by project: | Northwest Kansas |
Applicant organization information
Please provide basic information about the organization interested in a grant.
Key contact for organization
| Name: | John Doe |
| Title: | Executive Director |
| Phone: | 555-555-5555 |
| Email: | johndoe@myorganization.org |
Application Preparer information (you)
| Name: | Jane Doe |
| Title: | Grant Project Director |
| Address: | 100 Main Street |
| City: | Mytown |
| State: | KS |
| Zip Code: | 00000 |
| Phone: | 555-555-5555 |
| Fax: | 555-555-5556 |
| Email: | janedoe@myorganization.org |
Narrative 1 - Goals, Strategies, & Objectives
| Provide the overall goal(s), objectives, and strategies for the project to demonstrate the logic model or theory of change involved. |
Narrative 2 - Proposed Project's Organization and Operations
| Describe the proposed project's organization and operations (who, what, when, where, and how). |
Narrative 3 - Innovation Funding Qualifications
| Explain why you believe the proposed project qualifies for innovation funding. |
Narrative 4 - Outcomes/Results
| Provide a concise statement of the anticipated outcomes or results at the end of the project period, including how you will measure them. |
Narrative 5 - Secondary Benefits
| Describe any secondary benefits (positive results beyond immediate services delivered) expected from the project. |
Narrative 6 - Project Director and Organization Qualifications
| Describe relevant qualifications of those expecting to direct the proposed project and the capacity of the applicant organization to successfully manage the proposed project. |
| If additional funding beyond the requested grant amount is needed for this project, please indicate from what sources you anticipate securing the additional funding. |
| Explain in general how requested grant funds would be used. (Equipment, Supplies, Training, Personnel, Facility, Consulting/Contractor, Administration, Etc.) If readily available, include rough approximations of where funds would be allocated, using the budget details link (not required at this stage). |
(Optional) Budget Details-- click here to enter budget line items