2014-2015 Healthy Active Living Grants: Supporting Healthy Families
Application
APPLICATION PROCEDURES
1. Responses to application questions must not exceed word limits.
2. Do not use attachments to answer grant application questions (excluding questions #2 and #14).
3. Attachments must include and are limited to:
a. 4 letters of support from the AAP Chapter President, Residency Program Director, Resident
Leader and Community Partner.
b. 16-month timeline
c. Budget not to exceed $25,000
This application is available on the Community Pediatrics Training Initiative (CPTI) website
(http://www2.aap.org/commpeds/cpti/opportunities.htm). Please note that all applications must be
submitted by email to Mala Bedient at mbedient@aap.org by 12:00 pm Pacific/2:00 pm Central/3:00
pm Eastern on Wednesday, August 21, 2013.
The 2014-2015 Healthy Active Living, Supporting Healthy Families, grants are generously supported by
the
CONTACT INFORMATION
Please list the individuals who are applying for this grant and will have an active role in its day-to-day
activities.
AAP Chapter Leader:
Name: Click here to enter text.
Title: Click here to enter text.
Email: Click here to enter text.
Phone: Click here to enter text.
Faculty Leader:
Name: Click here to enter text.
Title: Click here to enter text.
Email: Click here to enter text.
Phone: Click here to enter text.
Resident Leader (Must be a 1st or 2nd year resident):
Name: Click here to enter text.
Year in Residency: Click here to enter text.
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Email: Click here to enter text.
Phone: Click here to enter text.
PROJECT TITLE AND ABSTRACT
Title of proposed project: Click here to enter text.
Summary/abstract of the proposed project (250 word limit): Click here to enter text.
PROJECT DESCRIPTION
1) Describe in one sentence the overall goal of your proposed project. Click here to enter text.
2) Complete a 16-month timeline (January 1, 2014 – April 30, 2015) that showcases the key activities
associated with the following phases: planning, implementation and evaluation. Use template here.
Submit this timeline as an attachment to your application.
3) List the specific measurable objectives you are trying to achieve through this proposed project
(Include up to 5 objectives in a bulleted list).
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4) How will the proposed project engage and support parents in the community and clinical setting?
Please state specifically which target behaviors will be addressed in the proposed project (250
word limit). Click here to enter text.
COLLABORATION AND INTEGRATION
5) This grant opportunity has the potential to strengthen existing relationships and/or forge new
relationships. How, if at all, has the chapter and residency program partnered or collaborated in
the past? (150 word limit). Click here to enter text.
6) Identify the community partner(s) that will be part of your team. Describe how their experience
working within the community and with families will contribute to the proposed project (150 word
limit). Click here to enter text.
7) Describe the roles of the project team in accomplishing the day-to-day activities of the proposed
project. Please specify the roles of the AAP chapter, faculty and residents, and community
partner(s) (250 word limit). Click here to enter text.
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8) Address how your proposed program fits into the chapter’s activities and strategic plan AND how it
will be incorporated into community pediatrics training at the residency program (250 word limit).
Click here to enter text.
COMMUNITY AND TARGET POPULATION
9) Describe the community that will be served (150 word limit). Click here to enter text.
10) Describe the target population of your proposed project (specifically include the number of families
to be impacted and how these families will be recruited/engaged for the project) (150 word limit).
Click here to enter text.
EVALUATION AND SUSTAINABILITY
11) Describe how your project objectives listed in Question #3 will be measured (150 word limit). Click
here to enter text.
12) How will you know if the overall goal of the project was achieved? (150 word limit). Click here to
enter text.
13) Describe the potential long-term impact of your proposed project, including plans for sustainability
(150 word limit). Click here to enter text.
BUDGET
14) Click here to download the budget template. The budget detail and brief justification should not
exceed $25,000. Submit this budget as an attachment to your application.
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