Application for Stipend
AAP & UN Foundation Shot@Life
Education on Global Immunization Issues
Description: The American Academy of Pediatrics (AAP) is pleased to
provide 10 grants between $500 and $1500 to pediatric residents, AAP
members and/or AAP chapters to support an event that benefits the UN Foundation Shot@Life
program.
Program Goals: Shot@Life educates, connects and empowers Americans to champion vaccines
as one of the most cost-effective ways to save the lives of children in developing countries. By
encouraging Americans to learn about, advocate for and donate to vaccines, Shot@Life aims to
decrease vaccine-preventable childhood deaths and give every child a shot at a healthy life.
The American Academy of Pediatric is a founding partner of the Shot@Life Campaign. The
Academy’s goal is to mobilize pediatric leaders to support and accelerate global vaccine access
and delivery goals. Working with Shot@Life provides pediatricians the opportunity to talk to
the public and U.S. government stakeholders about the critical role of vaccines in saving and
improving the lives of children around the world. The AAP spreads the message that all kids
deserve a shot at life and offers resources to help pediatricians educate about the importance of
international vaccine-prevention programs.
These grants are for individuals or chapters who wish to implement a fundraising, educational,
or local engagement event to benefit the Shot@Life program.
Examples: Awardees may propose spending up to $1500 in a variety of ways. A few examples
are below, but by no means are exhaustive of the possibilities. Creativity is encouraged!
 Host a local advocacy or community engagement event to educate local community
leaders about global immunizations.
 Hold an event at your chapter to educate your chapter members about global
immunization issues and the Shot@Life campaign.
 Hold a reception for pediatricians to raise awareness of global immunization priorities
and Shot@Life.
 Implement an in-office or community fundraiser, educating parents in your practice or in
your community about the impact of global immunization efforts and asking them to
contribute to Shot@Life. See
http://www.youtube.com/watch?v=ehdNbnECD6U&feature=plcp for one example.
Requirements:
 The funds must be used by March 30, 2013.
 Applicants must be AAP members, residents or trainee members, AAP members, or must
be applying on behalf of an AAP chapter.
 The focus of the proposed activities should be on education, community engagement,
and/or fundraising. Funds may not be used towards political lobbying activities.
 AAP staff will provide guidance and technical assistance. However, chapters and
individuals will be responsible for implementing their proposal. AAP may be able to
provide limited quantities of Shot@Life materials.
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The proposal should focus on immunizations in a global context. Connecting the issues to
domestic immunization is acceptable and encouraged, but domestic immunization issues
may not and should not be the exclusive focus.
No alcohol may be purchased with these funds.
A final report is due to the Academy no more than 1 month after completion of activities.
This report will be compiled with other reports and may be publicized in Academy media
outlets, such as AAP News.
Applications: Applications are due by January 4, 2013. Send completed applications or
questions to Terrell Carter, Manager, Global Immunization Programs, at tcarter@aap.org and
Elizabeth Sobczyk, Manager, Immunization Initiatives, at esobczyk@aap.org.
Name of Applicant:
(Individual or AAP Chapter and Chapter Staff Contact)
________________________________________________________________________
E-mail and Phone Number: _________________________________________________
In 300 words or less, please describe your project. Describe who will be involved, whether
the focus is primarily education or involves fundraising, and the timeline for completion.
Will you be requesting Shot@Life materials from the AAP (eg, posters, brochures, etc)?
Please describe your budget and explain how the funds will be spent. Each budget line item
must include an expense justification and clearly support the project objectives outlined in the
proposal. (See sample budget below for more details.)
Have you received input on this application from the following people?
Yes
No
Our Chapter does
not have one
Chapter Executive Director
Chapter Immunization or Global
Immunization Champion
Chapter Immunization
Committee Chairperson
Applications are due by Friday, January 4, 2013 at 5:00pm.
You may use this form and email it back as an attachment – or you may include the
required application questions on separate pages.
For questions or to return this form, please contact Terrell Carter, Manager, Global
Immunization Programs, at 800/433-9016 x4319 or tcarter@aap.org, and Elizabeth
Sobczyk, Manager, Immunization Initiatives, at 800/433-9016 x4271 or esobczyk@aap.org.
Use of Grant Funds
Funding ultimately comes from the UN Foundation Shot@Life Campaign through a grant to the
American Academy of Pediatrics. Receiving an award does not constitute endorsement by the
UN Foundation. Grant funds must be used for activities to benefit the Shot@Life program.
Allowable Expenses
Community forums
Project staff salary
Consultant fees
Office expenses/supplies
Food for meals and snacks
Educational events
Unallowable Expenses
Construction
Capital equipment
Indirect costs/overhead
Alcohol
Lobbying
Sample Budget – “Pediatricians Supporting Polio Eradication Project”
Activity
Description/Formula
$ Amount
1 part-time staff
$20/hour x 10 hours
$200
Teleconference planning calls
with State Rotary leadership
$100/call x 2 calls
$200
Office supplies
$300
Food for event
$800
Total
$1,500