CHNA 15 Request for Proposals
Funding for Collaborative Grants
CHNA 15 is seeking applications for funding from non-profit entities. Up to two Collaborative Grants of up
to $25,000 will be made to projects to build meaningful collaborations (between 2 or more organizations
within one community or among communities). Applications must respond to at least one of the six CHNA
15 health priority areas listed below and apply the Healthy Communities approach (see Appendix A). The
focus of this grant is to fund meaningful collaborations that would be unlikely to happen without the
support of this grant.
Successful applicants will work collaboratively with their key partners (including representatives from
education agencies, community and faith-based organizations, businesses, and/or the health care sector)
to develop strategies (e.g. programmatic, policy, systems, or environmental change – see Appendix B) that
promote and sustain community-based health promotion and chronic disease prevention programs.
Collaborative projects must have a focus of at least one of the following 6 Health Priority Areas which
were identified through the
2011 CHNA 15 Community Health Assessment1.
Health Priority Areas (Health Topic Area)
1.
Depression & Anxiety (mental health)
4.
Isolated Residents (public safety)
2.
Substance Abuse (mental health)
5.
Access to Healthy Food (food and nutrition)
3.
Domestic Violence (public safety)
6.
Obesity & Overweight (food and nutrition)
While not required, applicants are encouraged to consider using this collaborative grant to work on two
inter-related priority areas. An example of working on two inter-related priority areas is using mobile
farmer’s markets to reach isolated residents. The two Health Priority Areas this would involve are Isolated
Residents and Access to Healthy Food.
Information Session (participation required) at 11 AM on January 12, 2016.
Notification of Intent to Apply must be emailed by January 22, 2016.
Proposals must be postmarked and emailed by March 4, 2016.
Awards will be announced by April 29, 2016.
Start-up is May 1, 2016 and project must be completed by November 1, 2017.
CHNA 15 (see Appendix D) - as part of a statewide effort to develop, implement, and integrate community
projects to effectively utilize community resources to create healthier communities - has the following
Mission Statement: We pledge ourselves to work together to build healthier communities through
community-based prevention planning and health promotion.
To enhance its purpose CHNA 15 established a vision statement as follows: We envision that each and
every community will be a safe and supportive environment that empowers community members to
develop self-esteem and personal responsibility to make positive and healthy life choices.
Funding for the CHNA 15 Collaborative Grant is provided by Winchester Hospital through the
Department of Public Health’s Determination of Need (DoN) process.
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1
CHNA 15.org www.chna15.org/resources
Proposal Narrative
We encourage thorough but concise responses.
(See Appendix C for Definition of Terms referred to in RFP.)
1. Project Description: 10 Points
a. Provide a shared statement of project purpose collaboratively crafted by all involved
partners. This should include why you feel that a collaborative approach is the most
effective way to get at this issue.
b. Provide a description of how the collaboration was formed, and how working together will
move this project forward.
c. State the CHNA health priority area(s) you are addressing, and the strategies you will use to
address this/these health priority area(s). Describe your anticipated impact and how you will
measure success.
d. Which one (or more) of the following activities does your project include:
 Direct Service
 Prevention
 Education
 Policy Change
 Other: ____________
2. Need: 15 Points
a. Using data from the CHNA 15 Health Assessment and Fact Sheets, and assessment or
planning data (e.g. town planning, etc.), provide justification for the need for this project.
Include the target population that will be impacted by your project (age – indicate adults,
youth elders; race, ethnicity, socioeconomic status) and the community(ies) that will be
impacted by your project. If relevant, describe the policy or system gap that project will
address.
b. Briefly describe how this project addresses the identified need.
3. Goals and Objectives: 25 Points (See Attachment 2) We encourage you to thoughtfully articulate
the steps of the project in a concise manner.
4. Collaboration and Sustainability: 30 Points
a. Complete the Collaboration Chart. (See Attachment 3)
b. Describe and address any current or anticipated challenges to the collaboration.
c. How will collaboration sustain the project after the funding period? How will the project
continue? Please explain.
d. Submit signed Letters of Commitment from two collaborators reflecting an understanding of
the project. Letters should indicate what relationship the writer has to the project and
specifically what role they agree to have in the project during and after the funding period.
5. Healthy Communities: 5 Points Select the Healthy Community Principle (See Appendix A) that best
reflects the intent of your project and describe how your project aligns with that Principle.
6. Budget: 15 Points (See Attachment 4) Complete the Budget and Budget Justification Form.
Contact for questions or clarification: Randi Epstein, CHNA 15 Coordinator, at CHNA15Coordinator@gmail.com.
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CHNA 15 2016-2017 COLLABORATIVE GRANT
Attachments
Attachment 1:
CHNA 15 2016-2017 Collaborative Grant Cover Page
Attachment 2:
Goals and Objectives Charts
Attachment 3:
Collaboration Chart
Attachment 4:
CHNA 15 Collaborative Grant Budget Form and Justification
Attachment 5:
CHNA 15 Collaborative Grant Agreement
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Attachment 1
CHNA 15 2016-2017 COLLABORATIVE GRANT COVER PAGE
SUBMISSION DATE: ____________________________
PROJECT TITLE: _____________________________________________________________________________
PROJECT DESCRIPTION:____________________________________________________________
__________________________________________________________________________
LEAD AGENCY/ ORGANIZATION :_________________________________________________________________
CONTACT PERSON: ___________________________________________________________________________
PARTNER ORGANIZATIONS/COMMUNITIES INVOLVED IN THE COLLABORATION (PLEASE ADD LINES AS NECESSARY):
PARTNER ORGANIZATION/COMMUNITY A:_________________________________________________________
PARTNER ORGANIZATION/COMMUNITY B:_________________________________________________________
PARTNER ORGANIZATION/COMMUNITY C:_________________________________________________________
FOCUS AREA: PLEASE PUT A CHECK TO THE LEFT OF THE FOCUS AREA(S) YOU WILL ADDRESS:
Health Priority Areas (Health Topic Areas)
1. Depression & Anxiety (mental health)
4. Isolated Residents (public safety)
2. Substance Abuse (mental health)
5. Access to Healthy Food (food and nutrition)
3. Domestic Violence (public safety)
6. Obesity & Overweight (food and nutrition)
LEAD AGENCY/ ORGANIZATION STREET ADDRESS:__________________________________________________
CITY:_____________________ STATE:_____ ZIP: _________ PHONE:(___)______________________________
FAX: (___)_____________ EMAIL:_____________________________ WEBSITE:_________________________
AMOUNT OF FUNDING REQUESTED: $______________FEDERAL TAX ID #__________________________________
GEOGRAPHIC AREA SERVED BY PROJECT:_____________________________________________________________
HAS YOUR AGENCY RECEIVED ADDITIONAL CHNA 15 FUNDING TOWARD THIS PROJECT? ____YES
____ NO
IF YOUR ORGANIZATION HAS A FISCAL AGENT/CONDUIT OTHER THAN THE APPLICANT NAMED ABOVE, PLEASE COMPLETE
NAME OF FISCAL AGENT/ CONDUIT: ______________________________________________________________________________________________
NAME OF FISCAL CONTACT PERSON: ______________________________________________________________________________________________
ADDRESS: ________________________________________________________________________________________________________________
CITY:__________________________________________
PHONE: (____)___________________________
STATE:__________
ZIP CODE: ___________________________
FAX: (___)__________________________ EMAIL:_________________________________________
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Attachment 2
Goals and Objectives Chart
Use 10 point font in chart.
Timeframe: For the timeframe below, list month and year (e.g. 8/16-10/16)
SMART Goals: We ask for SMART goals below. SMART goals are: S – Specific, M- Measureable, A- Attainable, R-Relevant, T-Time-bound.
Number of goals to be determined by applicant.
Timeframe
Example
3/16-11/16
Goal 1 (SMART): By November 2017, recommendations for mobile farmer’s market sites are presented to the following Smalltown
decision makers for approval: Mayor’s office, Smalltown housing authority, Smalltown Department of Public Works, etc.
Activities:
 Review census data and work with partners to collect input from residents to identify mobile farmer’s market sites.
 Draft proposal for each new site.
 Meet with individual site decision makers (for example, housing authority) to present proposal for mobile farmer’s market
site.
Measureable criteria for success:
 Demonstrated support for new farmer’s market sites through data collected from site residents.
 Tailored proposals are crafted for each new site.
 Presentations are made to decision makers
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Timeframe
Goal 1 (SMART):
Activities:

Measureable criteria for success:

Timeframe
Goal 2 (SMART):
Activities:

Measureable criteria for success:

Timeframe
Goal 3 (SMART):
Activities:

Measureable criteria for success:

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Timeframe
Goal 4 (SMART):
Activities:

Measureable criteria for success:

Timeframe
Goal 5 (SMART):
Activities:

Measureable criteria for success:

Attachment 3
Collaboration Chart
Use 10 point font in chart
*One collaborator much be identified as lead
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Attachment 4
Organization: lead*
and partners. Please
list lead in first row
and partners in
subsequent rows.
Contact
Person
Clearly define the role of each
partner in implementing this
project
Unique Strengths partner
brings to the collaboration
Clearly define the role of
each partner in
sustaining this project
Indicate whether this
is a NEW or PREEXISTING collaborator
CHNA 15 Collaborative Grant Budget Form
Itemize all expenses and summarize all revenue and in-kind support for the project
Line Item*
Amount Requested in Application
Name of Lead:
Name of
Partner 1:
Name of
Partner 2:
In-Kind (source
and Amount) and
Other Sources
Name of
Partner 3:
Total Project Costs
Name of
Partner 4: (add
columns to the
right as needed)
Staff
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Fringe
Contract
Services
Travel/
Supplies
Equipment
Agency
Overhead
Other Expenses
Total
*Definitions are listed on next page.
Partner: Indicate organizations actively involved in discussion and development of project.
Staff: Indicate number of hours to be applied to this project and hourly rate.
Fringe: If applicable. (Check with your agency for how this is calculated and include a breakdown of included charges.)
Contract Services: Identify contractor and number of hours.
Capital Expenses: Capital expenses include equipment purchases. Capital Expenses may not exceed 10% of requested budget unless
justification is provided as to why additional capital expense funds are needed for project success AND a clear plan for ongoing
sustainability, maintenance and storage is presented.
Agency Overhead: May not exceed 7% of requested budget.
Other Expenses: List and explain
In Kind: Indicate source and amount of donated goods and services provided by both partners and non-partners.
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Collaborative Grant Budget Justification
The budget justification must explain the relevant details of each line item. Justification should not include program details not
identified elsewhere in your proposal. If needed, additional space, not to exceed three pages, may be used.
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Attachment 5
CHNA 15 Collaborative Grant Agreement
If awarded a CHNA 15 Collaborative Grant, we agree to the following:
Agreement A
 To ensure that at least one person representing our project will attend each CHNA 15
General Meeting to share achievements and updates.
Agreement B


To submit
o A Progress Report by February 1, 2017 (template to be provided). Second payment will be made
after Progress Report is received.
o A Summary Report (template to be provided), plus evaluation and year-end itemized expense
sheet, to the CHNA 15 Coordinator by November 1, 2017.
To complete the project with all funds spent by November 1, 2017. Should there be unused
funds, they will be returned to CHNA 15.

To display and discuss the project at CHNA 15 Showcase in the spring of either 2017 OR 2018 – to be
determined by grantee.

If project is unable to proceed as specified in the application, the organization should contact the
CHNA 15 Coordinator as soon as possible and submit an addendum for proposed change. The CHNA
15 Steering Committee will consider the proposal. Continued funding is not an automatic guarantee.
Completion and other reporting requirements would remain, as specified in the original application.
To include the following statement in all funded project descriptions, products, and related publicity:
This project is funded through the CHNA 15 DoN funds from Winchester Hospital.
Project Title:_________________________________________________________________
Signature of Authorized Signatory (lead agency):____________________________________
Date:_______________________________________________________________________
Lead Agency:_________________________________________________________________
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CHNA 15 2016-2017 Collaborative Grant
Appendices
Appendix A
Healthy Communities Principles
Appendix B
Policy, Systems and Environmental Changes
Appendix C
Definition of Terms
Appendix D
CHNA 15 Information
Appendix E
Information Session Announcement and Important CHNA 15 Collaborative Grant
Dates
Appendix F
Eligibility and Assessment Criteria
Appendix G
Instructions for Submission of Responses
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Appendix A
Healthy Community Focus and Healthy Community Principles
CHNA 15 programming and funding efforts focus on establishing a broader, more comprehensive
approach to developing healthier communities. Healthy Communities is an approach to understanding
and improving health and well-being built on decades of work and the thinking of individuals and
organizations around the world.
The Healthy Communities concept facilitates new collaborations and brings together a variety of
community members to identify shared visions and to create new projects. CHNA Members are
encouraged to work toward creating healthier communities in each of the twelve CHNA 15 communities,
between or among organizations, or between CHNA 15 member towns.
Within Healthy Communities efforts, health is not merely access to healthcare and the absence of disease,
but strengthening positive social, mental, physical, economic and environmental conditions conducive to
health and well-being. The focus is deliberately broad to encompass the ideals of CHNA 15 as well as a
member’s agency’s mission. A healthy community is defined as one that supports the health and welfare
of its members by following the Healthy Community Principles as listed below.
Healthy Community Principles
Source: Darvin Ayre, Gruffie Clough, Tyler Norris Principals, Community Initiatives, LLC.
Communities across the nation are using a variety of change models and planning processes to work together
to achieve their vision of improved health. Regardless of approaches taken to meet their challenges, the
following principles are guiding the most successful initiatives.
A broad definition of "health" Health is not just the absence of disease. Health is defined broadly to
include the full range of quality of life issues. It recognizes that most of what creates health is lifestyle- and
behavior-related. Other major factors are genetic endowment and the socio-economic, cultural and physical
environment. Health is a by-product of a wide array of choices and factors, not the simply the result of a
medical care intervention.
A broad definition of "community" By using as broad a definition as possible of what makes up a
community, individuals and partnerships can address their shared issues in the most fruitful way possible.
Communities are inclusive and can be based on faith, perspective, land and profession, as well as being
determined by geographic lines.
Shared vision from community values A community's vision is the story of its desired future. To be
powerful and inspiring, a community's vision should reflect the core values of its diverse members. A vision is
not just a statement on the wall - it is a living expression of shared accountability to priorities.
Address quality of life for everyone Healthy communities strive to ensure that the basic emotional, physical
and spiritual needs of everyone in the community are attended to.
Diverse citizen participation and widespread community ownership All people take active and ongoing
responsibility for themselves, their families, their property and their community. A leader's work is to find
common ground among participants, so that everyone is empowered to take direct action for health and
influence community directions.
Focus on "systems change" This is about changing the way people live and work together. It is about
how community services are delivered, how information is shared, how local government operates, and how
business is conducted. It's about resource allocation and decision making, not just "nice" projects.
Build capacity using local assets and resources This means starting from existing community strengths
and successes and then investing in the enhancement of a community's "civic infrastructure." By developing an
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infrastructure that encourages health, fewer resources need to be spent on "back end" services that attempt to
fix the problems resulting from a weak infrastructure.
Benchmark and measure progress and outcomes Healthy communities use performance measures and
community indicators to help expand the flow of information and accountability to all citizens, as well as to
reveal whether residents are heading toward or away from their stated goals. Timely, accurate information is
vital to sustaining long-term community improvement.
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Appendix B
Policy, Systems and Environmental Changes
We recognize that policy, systems, and environmental changes may involve more than the 18 months
specified in this grant. Efforts that are clearly linked to, and provide a foundation for the goal of policy,
systems or environmental changes, will be considered as well.
The following definitions are derived from the CHANGE Action Guide (see the glossary of terms in the
Center for Disease Control and Prevention’s Healthy Communities Program CHANGE Action Guide for
more information)1.
Systems change: A change that impacts all parts of an organization, institution or system. It often
includes changes in policies. For an example of systems change, see the Success Story example B in
Appendix C titled “From Farms to Lunch Trays: Island Schools enjoy healthier foods all day long.”
Environmental Change (Environment): Environmental Change can include physical changes to the
environment or changes to social or economic factors in order to influence behavior. For an example of
environmental change, see the Success Story in example C in Appendix C titled “Safely Connecting
School Children to Spaces to Play.”
Policies: Rules, including procedures, protocols, regulations or laws, created to guide or influence
behavior. The examples cited above also include some aspect of policy change.
1
CDC Healthy Communities Program CHANGE Action Guide
http://www.cdc.gov/healthycommunitiesprogram/tools/change/pdf/changeactionguide.pdf Accessed July 19,
2013.
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Appendix C
Definitions of Terms2
Lead: The lead is responsible for overseeing the grant, and making sure that the project is moving
along with team. The lead is also the primary contact person for the CHNA with respect to
questions and reporting. Funding is given to the lead, and then is dispersed according to the
proposal. The lead has ultimate responsibility for the grant.
Partner: All organizations involved in the development and implementation of the project.
Goal: The goals state in broad terms what you want to accomplish. They incorporate the
purpose and the outcomes.
Objective: Objectives state in measurable terms the desired outcomes of the project.
Outcome: An outcome objective describes a change or a result.
Activity: An activity is what the people who deliver the program do: provide counseling, teach
classes, create websites, make art, etc. OR what the people who receive program services or
participate in programs do: attend counseling sessions, go to class, use websites, make art, etc.
An activity is a task, a method, an approach, an ACTION.
Sustainability3: The continuation of community health and quality of life benefits over time 2
achieved through the availability of other resources necessary to implement the work, or
through other strategies.
SMART Goals: SMART goals are: S – Specific, M - Measureable, A - Attainable, R - Relevant,
T-Time-bound.
Definitions of “Lead, Goal, Objective, Outcome, and Activity” are from a Grant writing training
conducted by Cynthia Barger for the Regional Center for Healthy Communities (Metrowest).
3
Sustainability Toolkit, Center for Civic Partnerships
2
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Appendix D
Website: www.chna15.org
CHNA 15 is one of 27 Community Health Networks across Massachusetts created by the Department of
Public Health in 1992. Active since that time, CHNA 15 is a partnership between the Massachusetts
Department of Public Health, Regional Center for Healthy Communities, residents, hospitals, local service
agencies, schools, businesses, boards of health, municipalities, and other concerned citizens who work
together through local collaborations to:
 identify health needs of member communities,
 find ways to address those needs, and
 improve the social and physical health of the community.
CHNA 15 is composed of citizens from Acton, Bedford, Boxborough, Burlington, Carlisle, Concord,
Lexington, Lincoln, Littleton, Wilmington, Winchester and Woburn. Participation is open to those
interested in joining others to work toward the goal of healthier communities.
Recent CHNA 15 activities include the following:
 Completion of a CHNA-wide Community Health Needs Assessment to determine priority areas
of need as well as assets, strengths and resources existing in our communities that focus on
those needs. Results of the assessment drive interventions and funding allocations.
 Panel presentations at Healthy Community Resource Forums focusing on community needs as
identified by the Community Health Assessment and by members
 FY’2015 Community Trainings including: Adult Mental Health First Aid, Youth Mental Health First
Aid and Tips and Tricks for Grant-writing
 Awards of 20 FY’2015 Grants totaling $93,540.07 including:
o $35,846.17 awarded in 6 Mini Grants to area agencies
o $45,000 awarded in 3 Collaborative Grants
o $3,483.90 awarded in 6 individual & agency scholarships for Professional Development
o $9,210 awarded for 5 Capacity Building Grants
CHNA 15 activities are funded by Lahey Clinic, Mount Auburn Hospital, and Winchester Hospital through
the Department of Public Health’s five-year Determination of Need (DoN) process.
CHNA 15 members and associates
 network and share ideas with people with similar interest in building healthier communities,
 gain knowledge about a range of health related issues and topics,
 participate in designing and implementing health improvement projects,
 advocate for health issues that are important to their community,
 benefit from scholarships and Capacity Building Grants for themselves and their agencies,
 apply for grants for projects for community physical and social health improvement, and
 attend and/or provide a variety of trainings designed to enhance & strengthen community work.
Anyone interested in becoming involved, wanting information on activities, wishing to be added to
our ListServ, or any other opportunities offered by CHNA 15, may contact: Randi Epstein, CHNA 15
Coordinator, at CHNA15Coordinator@gmail.com or visit our website at www.chna15.org.
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Appendix E Information Session and Important CHNA 15 Collaborative Grant
Dates - CHNA 15
CHNA 15 will hold a Collaborative Grant RFP Information Session on Tuesday, January 12, 2016 from 11:00
AM – noon. The session will be held at Minuteman Senior Services, 26 Crosby Drive in Bedford (directions
below). The space is wheelchair accessible.
Information on the Collaborative Grant RFP and a question and answer opportunity will be provided. It
is required that potential applicants attend, including previous CHNA 15 grant recipients. Please bring
your copy of the RFP.
If you plan to attend the Information Session, RSVP to Randi Epstein, CHNA 15 Coordinator, at
CHNA15Coordinator@gmail.com.
Directions to Minuteman Senior Services
FROM ROUTE 128, NORTH OR SOUTH:
 Take Exit #32 A-B Middlesex Tpk/Burlington/Lowell onto US-3 N toward #32A/Lowell/Nashua, NH
 Follow directions below for Route 3 North
FROM ROUTE 3, NORTH OR SOUTH:
 3 N – Take Exit # 26 (Rte. 62 Burlington/Bedford), towards Bedford. This will be Burlington Road.
Follow through set of lights onto Crosby Drive. Follow straight approximately .3 miles and turn left
at Crosby Corporate Center 20-26 (blue sign). Take your first left into parking area then an
immediate left into the parking lot located directly across from Minuteman Senior Services.
 3 S – Take Exit # 26 (Rte. 62 Burlington/Bedford), towards Burlington. At set of lights, turn left onto
Burlington Rd. (Rte. 62 East). At the next set of lights, turn left onto Crosby Drive. Follow straight
approximately .3 miles and turn left at Crosby Corporate Center 20-26 (blue sign). Take your first
left into parking area then an immediate left into the parking lot located directly across from
Minuteman Senior Services building.
 Visitor parking area is located across from our building, there is a pathway in the far corner of the
parking lot that leads across the street to our main entrance.
 MINUTEMAN SENIOR SERVICES (No. 26) building is on the right (once you turn at the Crosby
Corporate Center 20-26 blue sign), located across from the main parking area. We share a
building with EMC 2 and The Schwabel Company.
Important CHNA 15 Collaborative Grant Dates
January 12, 2016
January 22, 2016
March 4, 2016
By April 28, 2016
May 1, 2016
February 1, 2017
April 2017 OR
April 2018
May 2016 and
May 2017
November 1, 2017
Information Session at 11 AM at Minuteman Senior Services.
Notification of Intent to Apply must be emailed.
Proposals must be postmarked and emailed.
Awards announced.
Project start up. Recipient awarded 50% of project funds.
Mid-project report due. Remaining 50% of project funds awarded upon receipt of mid-project
report.
Report due for CHNA 15 Showcase 2017 OR 2018 booklet.
CHNA 15 Showcase featuring Collaborative Grants and other CHNA 15 funded projects.
Collaborative grant recipients will be required to participate in either the 2017 or the 2018
Showcase.
Projects must be completed. Summary report, evaluation, and project-end itemized expense sheet
due.
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Appendix F Eligibility and Assessment Criteria
Eligibility
CHNA 15 is seeking applications for funding from non-profit organizations and/or public
entities including service providers, health and community-based organizations and coalitions,
municipalities, schools, and communities of faith who are interested in improving community
health. Hospitals are not eligible for funding, but are encouraged to participate as partners.
Previous recipients of a CHNA 15 Collaborative Grant are not eligible. Previous recipients of all
other CHNA 15 grant(s) are eligible.
Eligibility Requirements:
 Applicant must serve people in one or more of the CHNA 15 communities.
 Collaboration must be demonstrated and a lead agency identified.
 Lead applicant must be a tax-exempt 501C3 under the IRS code or a public entity. If
applicant is not a 501C3 they must have a Fiscal Agent who is a 501C3 or partner with an
agency with an IRS designation as a 501C3, a Section 170, or other IRS non-profit
designation.
Collaborative Grant Application Requirements and Assessment Criteria
Budget Exclusions and Requirements:
 No application may exceed a $25,000 budget request.
 Capital expenses may not exceed 10 % of the total budget unless justification is provided as to
why additional capital expense funds are needed for project success AND a clear plan for ongoing
sustainability, maintenance and storage is presented.
 If agency overhead is included, it may not exceed 7% of the total budget.
 Grant funds can be spent only on staff and expenses related to the Collaborative Grant project.
Proposals will be evaluated against the following Assessment Criteria:
 Complete numbered responses to all Application Components
 Likelihood of potential success with project
 Content and Quality of the proposal – as considered by reviewers: Content is an assessment of
whether the applicant has responded to each sub-section of the Question; that is, the presence
or absence of the required information. Quality of a response is its degree of excellence.
A copy of the Reviewers Proposal Score Sheet will be available at the Information Session on January
12, 2016 and on the CHNA 15 website, www.CHNA15.org, after the Information Session. The Score
Sheet is intended to expand your understanding of Content and Quality for each proposal question.
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Appendix G Instructions for Submission of Responses
1. Attend an Information Session on January 12, 2016 at 11 AM at Minuteman Senior Services. (See
Appendix E for details.) It is REQUIRED that potential applicants attend, even if you have previously
applied for a CHNA 15 Grant.
2. Submit a Notification of Intent to Apply by email by January 22, 2016. The Intent to Apply may be
brief including organizational contact information: e-mail address, phone number, contact
person, and community/ies and/or organization(s) your proposal will likely include.
3. Submit both electronic and hard copies of proposal. An emailed copy is due by 5 PM on March 4,
2016. One (1) original copy of your proposal, marked Original, plus five (5) copies must be
postmarked by 5 PM on March 4, 2016. Proposals postmarked or received via email after the
deadline will not be eligible for review or funding. All applicants will receive notification of receipt
of proposals.
4. Applications that do not meet ALL requirements will NOT be considered. No exceptions.
Submit Notification of Intent to Apply and proposals via mail and email to: Randi Epstein, CHNA 15
Coordinator, 59 Bonwood Road, Needham, MA 02492 and CHNA15Coordinator@gmail.com.
 Proposals must be written on plain 8 ½ x 11 inch paper, single-spaced,
twelve point Arial font, and single-sided with one-inch margins.
 A 10 point Arial font may be used for the charts in Questions 3, 4, and 7.
 Your response to proposal narrative questions must be numbered and correspond to the numbered/
lettered format. (2a, 2b, etc.)
Application Requirement Checklist
Completed CHNA 15 Collaborative Grant Cover Page as the first page of submitted proposal
Project narrative with responses to questions 1-6
Completed Budget Form and Justification. 3-page limit.
Signed CHNA 15 Collaborative Grant Project Agreement
Documentation of Tax Exempt Status or, if applicable, verification of designated Fiscal Agent and
501C3 of that agent
No more than two signed Letters of Commitment from community collaborators
Electronic copy submitted
One original and five hard copies of proposal submitted
Applications that do not meet ALL of the above requirements will NOT be considered. No exceptions.
Unrequested attachments will not be reviewed.
Copies of the RFP and all attachments are available at www.chna15.org
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