CHNA 15 2015-2016 Capacity Building Grants Available!
Between July 1, 2015 and June 30, 2016 six Capacity Building Grants of up to $2,000 each are offered to agencies in
the twelve CHNA 15 communities. Grants are available to build capacity or to respond to a community health need.
The broad definition of capacity building may include development of small projects, marketing, fund raising,
consultant support, web or print based resources, and enhancement of office administration.
Examples of previously funded projects include:
 Service Resource guides including: parenting resources, newcomer resources, senior resources, legal resources,
and more.
 Website and Outreach Materials development,
 Technology Enhancements to support emerging needs within programs and organizations,
 Tips for Healthy Aging resource,
 Area Transportation Directory,
 Elder Housing Options and Long-Term Care Facilities Directories,
 Youth Resources including: Celebrating Parenting Calendar, Child and Adolescent Eating Disorders: What to
Look For & How To Help, Red Flags and Resources – A Guidebook for Spotting Youth Risk Behaviors, Parenting
Your Teen Through Thick and Thin,
 Wilmington Walks! Walking Guide,
 Domestic Violence Victim Handbook,
 Safe and Sound: Preventing Medication Mishaps, and
 Health and Wellness Events.
To apply an organization/entity must serve one or more of the 12 communities in CHNA 15. Non-profit organizations
and/or public entities may include municipalities, schools, not-for-profit health institutions, services, and community
groups. Evidence of your organization’s collaboration with community partners will be viewed favorably.
Recipients may apply for a Capacity Building Grant every other year.
Applicants must submit the Capacity Building Grant Application, a detailed outline, example of previous project, or
If funded by CHNA 15, the applicant is expected to
1. Include the following in any publicity about the project: “This project was funded through a grant by CHNA 15,
the Northwest Suburban Health Alliance, and was made possible by Determination of Need funds received
from Lahey Hospital & Medical Center and Winchester Hospital.”
2. Submit a final budget and a brief description or completed copy of a print or web-based project to CHNA 15
within twelve months of award date.
3. Provide a brief report to be included in the CHNA 15 Showcase Bookelt.
To apply: Mail your completed Capacity Building Grant Application and attachments to: Randi Epstein, CHNA 15
Coordinator, 59 Bonwood Road, Needham, MA 02492 and email a copy of your completed Capacity Building Grant
Application and attachments to: CHNA15Coordinator@gmail.com. You will be notified of receipt of the application
and, within a month of submission, a response regarding an award. Projects must be completed within twelve months
of the date of award notification. Should you have questions you may contact Randi Epstein, CHNA 15 Coordinator, at
CHNA15Cooordinator@gmail.com.
CHNA 15 2015-2016 Capacity Building Grant Application
Please do not submit a hand written application.
Date: _________________________
Applicant Organization Name/Information:
_________________________________________________________________________________
Name
______________________________
Address
_________________________________________________
City/Zip
_________________________________
Project Director/Contact
______________________________________________
Phone/ Email
Proposed Capacity Building Project Title:
_________________________________________________________________________________
Amount of Funding Requested: ____________
Total Project Cost: _____________________
Source of balance of funding, if applicable: _____________________________________________
Tax ID #: _____________________________
Have you received a CHNA 15 Capacity Building Grant in the past two years? Yes ___ No _____
If there is a fiscal agent/conduit other than the applicant named above, complete the following:
____________________________________
Name of fiscal contact person
_________________________________________
Name of fiscal agent/conduit
__________________________ _________________________ __________________________
Telephone Number
Fax Number
Email Address
Working together to build healthier communities
through community-based prevention planning and health promotion.
Response to questions 5-11 limited to two pages.
You are encouraged to use the full two pages and provide sufficient details
for reviewers to better understand your intended project.
1. If you are a service provider, which population/health priority areas do you serve? Check all that apply.
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Housing/Homeless
Substance Abuse
Mental Health
HIV/AIDS
Health Care
Depression & Anxiety
Isolated Residents
Domestic Violence
Other (specify)

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General Population
Older Adults
Youth/Children
Immigrants
Early Intervention
Access to Healthy Food
Obesity & Overweight
2. What is the target population for this project?
 Youth
 Adults
 Elders
 Other (please specify):
Please include any additional demographic information that might be helpful for reviewers here:
3. What communities will be impacted by this project? Please list:
4. Which of the following health priorities does your program address (you can check more than one)?
 Food and Nutrition
 Mental Health or Behavioral Health
 Public Safety
 Elder Health
 Other (please specify):
5. Define the need for the proposed Capacity Building project and explain how you determined the need.
6. Explain how this project responds to the identified need.
7. How will you get input on the intended content of the project from those who will benefit from the
project?
8. Define your criteria for success for this project and indicate how you will measure success.
9. What prior experience do you have that will assist you in the development of the proposed project?
10. How will your organization make this project of use to others in your community and CHNA 15?
11. Do you anticipate revenue from the proposed project? If you do, where will the funds go and how will
they be used?
12. To illustrate your planning process and/or concepts for this project, present an outline for the project or
an example of a previous project. If this is a new web-based or printed project attach a mock-up of your
concepts for the project.
I am submitting: Project Outline ____ Project Mock-Up ____ Example of previous project ____
13. Attach a completed budget form (See Budget Template on next page.).
CHNA 15 Capacity Building Grant Budget Form
Itemize all expenses and summarize all revenue and in-kind support for the project.
Line Item
Amount
requested in
application
IN-KIND
(source and
amount)
OTHER
SOURCES
TOTAL PROJECT
COSTS
(source and amount)
Staff
(Indicate number of hours to
be applied to this project and
hourly rate.)
Supplies
Other Expenses
(list and explain)
TOTAL
Capacity Building Grant Budget Justification
Justification is requested for each line item indicated above and should not include program details not
identified elsewhere in your proposal.