Appendix

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Answers to Tests

 

Lesson Seven

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Lesson Eight

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Lesson Nine

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Sample Proposal Documents

• Sample Letter of Intent
• Sample Letter of Inquiry
• Sample Cover Letter
• Sample Request For Proposals
• Sample Program Budget Form Showing Sources and Uses Format

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All samples are the property of Dianne Harris of Atlantic Publishing Group, Inc

Sample Letter of Intent

Note: This is a fictitious proposal. Neither the organization nor the staff members exist. Any similarity to actual persons or organizations is coincidental. However, the format is intended to demonstrate an effective method of submitting a proposal to a foundation for a human services activity.

Ralph S. Jones, Administrator
Alzheimer’s Center of the Midwest, LLC
11111 Pittman Ave.
Columbia, Ohio, 43200

January 1, 2007

Mr. J. Donald
Victor Donald Foundation
44444 Pittman Ave.
Columbia, Ohio 43200

RE: Dementia Care Innovations Grant
Notice of Funding Availability: # 2007-0200-005
Dated: November 2, 2006

Dear Mr. Donald:

This letter is to advise the Victor Donald Foundation of our intent to apply for the new Dementia Care Innovations Grant in the upcoming competitive application round due February 15, 2007. This Letter of Intent is in response to the instructions issued with the grant Notice of Funding Availability issued November 2, 2006.

The Alzheimer’s Center of the Midwest, LLC, a subsidiary of Alzheimer’s Care Centers of America, will be the applicant for the Dementia Care Innovations Grant. We may be reached for additional information at the above address in care of Mr. Ralph S. Jones, Administrator, or by phone at 999-388-8226.

Thank you for the opportunity to apply for these important funds.

Sincerely,

Ralph S. Jones, Administrator
Alzheimer’s Care Center of the Midwest. LLC

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Sample Letter of Inquiry

Note: This is a fictitious proposal. Neither the organization nor the staff members exist. Any similarity to actual persons or organizations is coincidental. However, the format is intended to demonstrate an effective method of submitting a proposal to a foundation for a human services activity.

Backwoods River Nature Center
100 River Ave.
Columbia, Ohio 43200

January 1, 2007

Ms. June Forester
Natural Resources Alliance
200 Lake Ave.
Columbia, Ohio 43200

Dear Ms. Forester:

The founding Board of the Backwoods River Nature Center is writing to inquire about your interest in supporting a new educational initiative of the Backwoods River Nature Center. This is a program initiative serving the students of the Columbia Public Schools. This will be a program that will provide instructional resources in middle school classrooms for a new natural science and environmental studies unit. The unit has been designed with the objective integrating math, science, reading and writing skills into a cross-functional and interdisciplinary approach. The unit is designed to provide students with the skills to meet 8 of 15 requirements of the ninth grade proficiency test in mathematics, 10 of 12 requirements of the ninth grade proficiency test, and to reinforce reading and writing skills that are required at this grade level.

The unit will also include presentations about the ecology of the Backwoods River Basin and the geologic and human history of the Basin. Students will visit the nature center once each grading period for field survey work. In school laboratory projects and demonstrations will include replicating natural processes of erosion, observing the impacts of reduced dissolved oxygen on aquatic plants, and the life cycles of insects native to the Basin. Math skills developed will include metric measurements and conversions, organizing date into tables and graphical analysis as well as computations of expected and actual results of lab exercises. Students will read the results of research into similar river basin ecologies. They will write two term papers, one at the midpoint of the year about their literature search, and one at the end of the year about their conclusions after completion of the laboratory work and mathematical analysis.

The mission of the Backwoods River Nature Center is to provide experience based learning about nature and the Backwoods River Basin. A secondary benefit of the Nature Center and its management of the grounds is the protection of the stream and provision of passive recreation opportunities for the community.

The founding board is made up of business leaders and environmental professionals who have witnessed the toll of poor resource management resulting in flooding and loss of species diversity in the last century. The schools have approached us to assist them in creating an experiential curriculum that will help their students meet the requirements of the State mandated proficiency tests, particularly in the fields of science and mathematics. Thus this program was developed by a blue-ribbon panel of science and math teachers and park rangers at the Nature Center.

The community has responded enthusiastically to the project with volunteers, and donations of transportation for the students. In order to complete the launch of the project, we require funding for printing specialized curriculum materials and study guides and to acquire special laboratory equipment and supplies for the in school laboratory study. If invited to present a full proposal, the Nature Center will request $ 140,000 to meet the cost of a one year program for an estimated 700 students.

We appreciate your consideration of our program and look forward to the opportunity to meet with you to further discuss this request and the work of the nature center. For more information please feel free to contact me, Jeff Skinner, at 614-386-8115. Thank you for your consideration.

Sincerely,

Jeff Skinner, Executive Director
Backwoods River Nature Center

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Sample Cover Letter

The following is for a fictitious proposal. Neither the organization nor the staff members exist. Any similarity to actual persons or organizations is coincidental. However, the format is intended to demonstrate an effective method of submitting a proposal to a foundation for a human services or cultural activity. This fictional case is carried forward in the succeeding chapters and will be the sample of each element of a typical grant proposal.

Jones Dance Company
100 Main Street
Columbia, Florida 10002
Telephone: (999) 888-7777
Fax: (999) 888-7778
E-mail: happyfeet@internet.org
Mr. John Smith, Grant Review Coordinator
The My Town Foundation
P.O. Box 0000
Columbia, Florida 10001

January 1, 2007

Dear Mr. Smith:

Attached is a request for funding from the Jones Dance Company, a newly organized community dance troupe. The staff and volunteers of the dance company have raised a significant amount of community support for its service to the low income community through free live performances and dance instruction for teenagers in Columbia, Florida. However, the Jones Dance Company still faces a shortage of $15,000 for its first year budget to rent rehearsal and performance space. Because of the My Town Foundation’s interest in improving cultural opportunities and engaging youth in creative activities in low income neighborhoods, the Jones Dance Company hopes that the Foundation will provide a grant for the needed funds.

Please feel free to contact me at any time to address any additional questions you may have. You may reach me by any of the means listed at the above.

Thank you for your consideration.

Sincerely,

Joy LaFeet, Artistic Director / Grant Contact

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Sample Request For Proposals

GRANT WRITING SERVICES

FROM:

Towne Sports, Inc.
c/o Mary Jones
2001 Ashtown Rd.
Columbia, Ohio XXXXX
Phone: XXX-XXX-XXXX
Fax: XXX-XXX-XXXX

Dear Prospective Service Provider:

The Board of Trustees of Towne Sports, Inc., the leading provider of organized sports programming for youth aged 13-17 i Columbia, is requesting proposals for grant writing activities. Towne Sports, Inc. has identified a foundation from which to apply for funding for the purpose of replacing the surface of the outdoor running track owned by Towne Sports on 2001 Ashtown Road.

The Board is soliciting proposals from several service providers and reserves the right to negotiate the details of the final contract with the provider deemed most qualified to undertake this project., or to not accept any of the proposals received.

The proposal should address at a minimum:

• the provider’s statement of qualifications and experience with similar work,
• at least three client references, describing the work performed and a client reference and contact information,
• a project timeline outlining project milestones, and
• a cost proposal detailing project fees and expected expenses.

The proposal shall consist of no more than five pages secured by only one staple in the upper left corner. No other form of binding, please. Please submit 5 copies of the proposal to Mary Jones at the address above, no later than 4:30 PM, January 15, 2005. The Board will review the proposals and announce their selection at the next meeting of the Board, January 22, 2005. Work will be expected to begin no later than January 28.

Thank you for your interest.
Sincerely,

Mary Jones, Administrative Assistant
Towne Sports, Inc.

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Sample Program Budget Form Showing Sources and Uses Format

Source of Funds	Source Amount		Use of Funds	Cost
Corporate and private donations	$50,000		Salaries (including benefits) 2 @ $40,000 ea	$80,000
ABC Foundation (this application)	$41,800		Rent and utilities $700/month for 1 year	$8,400
Proceeds from spring flower sale fundraiser	$5,000		Office supplies and postage	$1,200
In kind donations (printing and advertising)	$ 1,000		Printing	$600
			Program materials	$1,200
			Contractual services	$2,000
			Notices and advertising	$400
			Travel and training 2 @ $2,000 ea	$4,000
	$97,800.00	-Total-		$97,800.00

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Sample Government Grant

Section A: Project Synopsis

Grant Title: MICRO BUSINESS GRANT PROGRAM

Applicant Information:

Grant Submission Date: ________________
Name of Community: _____________________
Contact Person and Title: _________________
Address: ______________________________
Phone: ________________________________
Fax: __________________________________
Email: _______________________________
Resolution to make application date of passage: _____________
Resolution number: ___________________________________
Federal Tax ID #:______________________
Project Budget: ________________________
Matching Funds: _______________________
Value In Kind Services: __________________
Grant Request: _________________________
Program Goals: _________________________

Section B: Need Statement

Though the city has enjoyed gains in its economy, its status continues to lag behind other communities in the county with respect to some economic measures. The median household income in 1999 was still only $35,681. The unemployment rate for the city tends to be similar to the county as a whole, which in June of 2005 was 5.7 percent, up from less than 5 percent in 2004. During the city’s annual planning process, micro business development was adopted as a strategy to assist low income households with creating their own job opportunities and self-reliance. The city first attempted a micro business program in 1992. The community was unable to loan out all the funds available, and a few loans have defaulted over the years. However, a few loans were successful and have generated enough program income to make two more loans since the end of the program.

The city gained valuable experience from this effort and has made design changes for the current proposal. The ability to use program income has maintained interest and knowledge of the program in the intervening years.

The JVS Business Enterprise Center (BEC) now offers the training and technical assistance on an individualized basis, rather than on a fixed college calendar. This removes the barrier of time and scheduling that was an issue in the 1992 program.

The previous experience indicated that loan recipients needed a more structured follow-up program to keep them accountable to their plans and providing interventions during the difficult first year. This should prevent loan delinquencies and defaults. The city learned that it is important to keep the door open for restructuring of loans to help applicants get past difficult business periods. This year’s program design features incentives, like free additional training in small business management as a reward for completing three hours of counseling with the business coach (from the BEC) and the opportunity to “pass a payment” for each set of 23 on-time payments over the course of the loan to help with difficult cash flow periods.

Section C: Program Description

Because the city is the grantee for these funds, the program will be limited to residents of the city that are seeking to operate businesses within the city. The program will be available city wide.

This program aims to increase employment opportunities for persons unemployed or under-employed in the current market place or for those with an entrepreneurial spirit through the creation or expansion of microenterprises. Small businesses have produced 71 percent of the 1.9 million new jobs created nationally between 1993 and 1997 and employ 54 percent of the private work force. These small enterprises are often considered too high risk for traditional lenders, and in a recent survey, 64 percent of one-year-old firms indicated that obtaining capital is their biggest concern.

Within the population, there are a number of households that tend to be less likely to participate in the traditional employment market and are less likely to access financing for small businesses through traditional lenders. These include those on ADC, unemployed, part-time employed, homemakers re-entering the work force, or any lower income person interested in starting their own business. In particular, 17.5 percent of the city’s households are of very low income (less than 50 percent of AMGI) and 56.7 percent of these are single parent households, all of whom, due to life situations or prejudice, may have difficulty obtaining employment in the general labor market. Home-based businesses provide a popular option for parents of small children at all income ranges.

The city is in the process of creating a set of marketing materials to be distributed to low- to moderate-income households to encourage their participation. These will include brochures, posters, and flyers to be distributed in as many locations as possible. These will include grocery stores, the Salvation Army offices, the homeless center, and the college extension office. There will be frequent newspaper press releases, as well as promotions on the public access television station, the city’s web site and the city’s newsletter.

Marketing of the program will be aimed at encouraging participation from the demographic groups cited above. Information concerning the program will be distributed through the city’s partners in community development efforts, including those represented in the loan review committee, as well as the YWCA and YMCA, the Public Library, and the city’s Community Development Office.

All partners sitting on the loan review committee will promote the program at their office locations, in public appearances they make to community groups, as well as in their general membership/ staff meetings. The Business Enterprise Center will promote information about the availability of tuition grants to their students and in recruiting materials.

Eligibility for the Program

Applicants:

• The business must employ five or fewer employees, including the owner.
• The business must be operating legally with proper licensing and not be delinquent in county, state, federal taxes, unemployment insurance, or workers compensation premiums.
• The business must not be in arrears in payroll or more than 60 days in arrears on any obligations to suppliers, utilities, rent, and so forth.
• The successful applicant must complete the Small Business Enterprise Center’s Micro Business Training Program prior to receiving loan funds. Tuition cost for this program will be provided by the City Micro Business Program as a grant.
• Upon completion of the training program and prior to use of loan funds, the applicant must have completed market research, a business plan, and set up an accounting system.
• Recipients of loan funds will be encouraged to participate in follow-up counseling and complete the Small Business Management series of training.
• The BEC will provide additional follow-up counseling monthly for one year after business start up, at no additional cost.

Eligible Uses of Loans

• The City Micro Business Grant Program funds may be used as follows:
  • To purchase capital equipment
  • For working capital (merchandise stock and supplies)
  • To make improvements in store interiors
  • To purchase store fixtures (for displays and the like)
• Ineligible Uses – The funds may not be used to pay salaries, fringe benefits, rent, or utilities

Section D: Goals

1. Tuition for training and technical assistance will provide ten applicants with Microenterprise Business Development Training at an average cost of $700 each.
2. Five recipients of direct loans or working capital loans will be given additional tuition grants of $600 for extended BEC counseling.
3. The program intends to provide loans to 5 micro businesses at an average of $8,900 each, with a maximum loan available of up to $10,000. It is expected that some, but not all, applicants will need both direct loans and working capital loans.
   1. To strengthen a collaborative program with local agencies to stimulate Micro Business to provide ongoing mentoring/coaching relationships with graduates with individualized follow-up counseling specific to their own businesses and situations.
4. To deliver further individualized training that goes into greater depth than the initial “curriculum” at a point when the business is ready for more sophisticated tools.
5. To provide the entrepreneur with a pathway to develop a relationship with a local lender for financial services and future capital needed to sustain their business successfully in the long-term future.
6. To continue the program in future years, built by a revolving loan pool from loan repayments.

Outcome	Measurement	Average Cost	Total Cost	(Maximum)
MicroE Training	10	$700	$7,000	$ 70 per hour
Small Bus Management Training (advanced counseling)	5	$600	$3,000	$70 per hour
Business Loans (Combined direct loans and/or working capital)	5	$8,900	$44,500	$10,000

Recruitment of interested individuals is already in process, and assistance will be provided on a first come/first served basis if the city’s grant application is funded. Recruitment will continue until all available loan funds are committed. This is a 12-month program starting in approximately December.

Monitoring Payments and Project Process

• The loan review committee (LRC) will receive monthly reports of each applicant’s attendance and progress in the training courses and upon the completion of the business plan.
• Upon final loan approval by the LRC, the applicant will be notified and a loan closing will be scheduled at the city Community Development Department.
• A purchase order for the loan amount will be processed. To the extent feasible, checks will be issued

In the event of numerous small purchases, the applicant will be required to submit invoices or proof of delivery/payment of the items. The CD director will later visit the premises and attempt to verify that appropriate purchases have been made and make a note in the file.

• The city will provide the applicant with payment coupons to be used with each month’s payment. Payments will be sent directly to the city auditor’s office, payable to the Microenterprise Account. The Finance Department will levy a $10 per month processing fee on each loan.
• The city auditor will transfer payments to the lender partner in proportion to their participation in each loan on agreed upon intervals, with a statement of loan status and receivables for the covered period.
• The auditor’s office will provide to the LRC monthly reports of payments and fund balances. Reminder notices will be sent if payments become more than 15 days late and again if 30 days late.
• If payments are 30 days late, the Training and Technical Assistance Provider will be requested to make contact with the business owner to provide intervention and counseling services. Renegotiation of the loan will be permitted if recommended to the LRC by the counselor.
• If payments become more than 90 days late without attempts to negotiate a solution, collection proceedings will begin.
• Recipients who successfully complete eleven (11) months in good standing will be allowed to “pass a payment” during any selected month thereafter, with the interest being added on to the end of the loan.

Recipients who successfully complete the course and remain in good standing regarding loan payments will be able to use the city’s program as a positive credit reference in future credit requests.

Section E: Organization Description and Qualifications

The city Micro Business Grant Program will be administered by the City Community Development (CD) Office with the assistance of a local review committee. The City CD Office in 1992 administered a Micro Business Grant Program which still provides a small amount of program income.

All training and technical assistance will be provided through a partnership with the JVS Business Enterprise Center (BEC). The BEC is an outstanding resource for the city’s micro business training needs. It already operates a Micro Business Program serving low income residents in the unincorporated areas of a four county area, which includes W, X, Y, and Z Counties. Their program was established to serve both new and growing companies. Their mission statement is:

“The JVS Business Enterprise Center, is dedicated to community economic development, and to serve as a resource for business startups and expansions.”

Organization of the Micro Business Grant Program

The program will be a collaborative with representatives that make up the loan review committee (LRC).

These are:

• The City Community Development Director
• JVS Business Enterprise Center Instructor
• Local Lender Partner/ Local Bank’s Representative

The City’s Community Development Director will have ultimate responsibility for functions of administration, as well as serving as the loan review committee liaison representing the city’s interests as grant recipients. The JVS Business Enterprise Center will be providing the training and technical assistance component of the program. Their experience and insight in this area will strengthen the assessments of an applicant’s potential to succeed with this assistance. The local lender partner, Local Bank, will serve on the loan review committee to represent the lender’s interests in underwriting a portion of each loan. Their representative will have responsibility for cultivating a business relationship with the applicant, linking them to other financial services, such as business checking accounts, and supporting them in developing their capacity to access future capital for expansion as needed. Direct program administration will primarily involve those described briefly above.

The CD Director will have responsibility for document preparation, scheduling, filing, and telephone contacts. Résumés are included at the end of this section.

Section F: Budget Summary Table

Activity Name		Total Cost	CDBG Federal	Other Funds	Outcomes
Direct Loans		$26,700	$21,000	$5,700	3 Loans
Working Capital Loans		$17,800	$14,000	$3,800	2 Loans
Subtotal		$44,500	$35,000	$9,500	5 Loans
Training/Technical Assistance		$10,000	$10,000		10 Training 5 Tech Assistance
Administration		$5,000	$5,000		1 Program Year
	Total	$59,500	$50,000	$9,500

Section G: Program Sustainability

This program will be sustainable over a great time period as loan repayments revolve to new loans. The city will attempt to recruit new applicants from students already enrolled in the JVS Entrepreneurial program in order to minimize expenditures for the training component, and to maximize the available funds for overcoming other costs of business start up and expansion. The number of new loans funded will stabilize to one to two per year. The City CD Department can absorb the monitoring activities for this level of activity within its current staffing and resources.

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Proposal Template

Fill in the blanks or answer the question and delete the prompts. Fill in more detailed information as needed. Revise as needed per individual foundation requirements.

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Cover Letter:

(From) Letter Head (or your name and address)

Date: __________________________________
(To) Contact Name: _______________________
Foundation Name: ________________________
Foundation Address: ______________________
City, State, Zip Code: ______________________
Dear M_(title)__(name)________:

The (name of organization) is pleased to submit this proposal for grant funding under the (name of grant program/ category). The (name of organization)’s (name of project or program) has been created to solve the problem of (state the major need) by (state the major activities).

The (name of project or program) addresses the concerns of the (name of foundation / and category or grant program name) because (state the features of the program that relate to the stated mission or interests of the funder).

The (name of organization) has obtained monetary and/or in kind support from the following: (list organizations, companies, and community leaders that have already pledged support).

The amount of this request: ( $XX,XXX).

For further information, please contact: (Primary Contact Name, title, phone number, and address) at (any other facts, such as office hours).

Sincerely,

(Signature of writer or CEO)

(Typed Name and Title)

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Table of Contents

Cover Letter Pg
Table of Contents Pg
Abstract Pg
Description of Organization Pg
Needs Statement Pg
Program Description Pg
Budget Pg
Goals and Measurable Objectives Pg
Program Evaluation Procedures Pg
Appendices Pg

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Abstract of Proposal

Request From: (Name of Applicant) _________ Total Project Cost: ___________________
Contact Name: __________________________ Other Funds Committed: _______________
Mailing Address: ________________________ Amount of This Request: ________________
Name of Project: _______________________________
Address of Project: _____________________________ (May be different than the organization’s main office)

Target Clientele:

Project Synopsis:

• (Briefly state why this project is needed)
• (Briefly state the activity)
• (Briefly state the method of delivery)
• (Briefly state the benefits to be attained by sponsoring this project)
• (Briefly state the number of units of service to be delivered)

Description of Organization

1. When was the organization founded
2. Mission of the applicant
3. What role does it fulfill in the community
4. State the connection between the funder’s objectives and the activities of this applicant
5. Names of board members
6. Skills they possess
7. Résumés of staff members
8. The applicant’s accomplishments
9. How many staff and volunteers are there

Statement of Need

1. This program was designed to address the problem of
2. The number of people affected by this problem
3. Special characteristics of those affected
4. Barriers to resolution of the problem
5. Source of this information
6. Other efforts that address the problem
7. Gap between size of problem and available resources
8. Cite other studies of the problem
9. Attach tables and graphs to illustrate the magnitude of the problem

Program Description

1. Who
2. Does What
3. When
4. Where
5. Why
6. How
7. Tell how the community has supported the organization and / or this project
8. Is this project duplicated in the community
9. Can this project be replicated easily in other communities
10. What is the project budget – revenues and expenses
11. What is the long-term financial plan for the organization and program
    1. Other funding sources
    2. In kind donation of services and materials

Goals and Objectives

1. What is the unit of service
2. How many units will be delivered
3. Secondary impacts
4. How many of those

Program Evaluation

1. Who will be responsible for program oversight
2. How will evaluations be conducted
3. How often will the program be evaluated
4. Who will review the evaluations
5. What will be the involvement of the board
6. What financial controls will be used
7. Address specific evaluation requirements of the funder

Summary

1. Closing statement summarizing the importance of this project in the community
2. Restate the connection between the funder’s objectives and the purpose of this project
3. Reminder that the funder’s support is vital to accomplishing the mission
4. Thank them for their consideration and support

Appendices

1. Copies of relevant media articles
2. Letters of support
3. Other exhibits that illustrate data
4. Certifications required by funder
5. Résumés if needed
6. Copies of audit reports if required
7. Copies of IRS letter of determination of tax exempt status if required
8. Portfolio material if requested
9. Photographs, videos, and the like only if permitted

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Complete Grant Proposal

(Recap of the hypothetical J.M. McCoy Health Center)

Sample Letter of Inquiry

Note: This is a fictitious proposal. Neither the organization nor the staff members exist. Any similarity to actual persons or organizations is coincidental. However, the format is intended to demonstrate an effective method of submitting a proposal to a foundation for a human services activity.

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J. M. McCoy Health Center
55555 Pittman Ave.
Columbia, Ohio 43200

January 1, 2007

Mr. J. Donald
Victor Donald Foundation
44444 Pittman Ave.
Columbia, Ohio 43200

Dear Mr. Donald:

The founding Board of the J. M. McCoy Health Center is writing to inquire about your interest in supporting the work of the J. M. McCoy Health Center, a new facility serving the low income Mill Town Neighborhood of Cols, Ohio. The mission of the health center is to serve the residents of the neighborhood who, because of lack of health insurance, lack of transportation, or lack of trust have had inadequate primary health care. The overarching philosophy of the health center is that instilling better health habits, vaccinations, and other preventative care will have greater and longer lasting benefits to the patient’s quality of life. The Victor Donald Foundation has been recommended to us as a supporter of preventative health care initiatives.

The founding board is made up of business leaders and health care professionals who have witnessed the toll in lost productivity and family disruption from complications of medical conditions left untreated for too long. Lack of access to a primary care provider often results in more expensive emergency room visits, stressing the capacity of the emergency care system as well. In this community, with a large immigrant population, language has also been a barrier to adequate care. The J. M. McCoy Health Center will also have multilingual staff on duty at all times. The center will provide counseling and classes for smoking cessation, weight management, and nutrition in its first year offerings.

The community has responded enthusiastically to the project with volunteers, donations of a facility, pharmaceuticals, and other needs to launch the project. There is an active campaign to create an endowment to cover a portion of future operations costs. If invited to present a full proposal, the health center will request $45,000 to close the gap in first year operations costs.

We appreciate your consideration of our program and look forward to the opportunity to meet with you to further discuss this request and the work of the health center. For more information please feel free to contact me, Joy Morning, Executive Director at 614-281-8211. Thank you for your consideration.

Sincerely,

Joy Morning, RN
Executive Director

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Sample Cover Letter

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Mr. J. Donald, Grant Review Coordinator
The Victor Donald Foundation
P.O. Box 0000
Columbia, Ohio 43200

January 1, 2007

Applicant:
J. M. McCoy Health Center
55555 Pitman Avenue
Columbia, Ohio 43200
Telephone: (614) 281-8211
Fax: (614) 222-8889
E-mail: mccoyhealth@internet.org

Dear Mr. J. Donald,

Attached is a request for funding from the J. M. McCoy Health Center, a newly organized community health center. The staff and volunteers of the health center have raised a significant amount of community support for its health care service to the low income community known as the Mill Town Neighborhood in Columbia, Ohio. The center still faces a shortage of $75,000 for its first year budget. Because of the Victor Donald Foundation’s interest in improving the health status of low income neighborhoods, the J. M. McCoy Health Center hopes that the Foundation will provide a grant for the needed funds.

The center is ready to address any additional questions you may have. You may reach the Grant Contact, Joy Morning, or the Executive Director, Elizabeth Noon, at the above numbers, addresses, and e-mails.

Thank you for your consideration.

Sincerely,

Joy Morning, Assistant Director and Grant Contact

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Grant Request from the Victor Donald Foundation
By the J. M. McCoy Health Center

Synopsis:

Grant Contact: Joy Morning

Executive Director: Elizabeth Noon

Staff:

• 2 part-time paid registered nurses (the Executive Director and Assistant Director)
• 25 Volunteers
• 5 person Board of Directors

Tax Status:

The J.M. McCoy Health Center is tax exempt per IRS Section 501(c)(3).

Request for Funding:

$ 75,000 (though any support will be appreciated)

Type of Organization:

Health Care

Service Area:

Mill Quarter Neighborhood and Mill County

Target Population Served:

Residents of service area needing health care

Mission:

To provide free health care to members of our community that cannot afford primary care, using an ethnically diverse outreach and advocacy program.

Abstract:

There is great need for primary health care in low income neighborhoods in Columbia, Ohio. Particularly the Mill Quarter neighborhood, which is ethnically diverse and fast becoming a port of entry for new immigrants to the city.

In general, low income persons and families tend to be uninsured and underserved by the medical community. Recent immigrants tend to be reluctant to approach traditional providers due to language and transportation barriers. Some of the Hispanic community may be reluctant to seek care until an emergency arises, due to concerns about challenges to their legal status.

Low income populations are far more likely to be affected by controllable conditions such as HIV/AIDS, STDs, obesity, diabetes, high blood pressure, and high cholesterol. Low cost health care that is located in the community is essential to reducing the long-term effects of these conditions. Additional services to reach out and educate the residents of the neighborhood about good health habits and the availability of primary care will distinguish this facility. Currently available facilities are unable to adequately serve this growing population.

The J.M. McCoy Health Center will be a new facility in the city and the first of its type in this neighborhood. The executive director and board members all have extensive experience in health care, administration, and in serving culturally diverse populations.

Several members of the community have joined the effort to create this facility, including existing health care organizations, the local business community, local colleges, technical schools, and community churches. The additional financial support of the Victor Donald Foundation will help make this facility a reality.

Table of Contents:

1. Needs Statement
2. Project Description
3. Project Mission, Goals, and Objectives
4. Monitoring and Evaluation
5. Organizational Capacity and Qualifications
6. Budget and Long-Term Sustainability
7. Summary
8. Appendices
   1. Letters of Commitment and Support
   2. Relevant Media Coverage

 

1. Needs Statement

There is a growing low income population of uninsured individuals and families in Columbia, Ohio and throughout the nation. The three other neighborhood health centers in the city are overtaxed. They increasingly find it difficult to adequately serve recent immigrants due to cultural and language barriers. The Mill Quarter neighborhood is the only quadrant of the city that does not have a community-based health care center. There are no doctor’s offices or non-subsidized health care facilities in a three-mile radius of the proposed location of the J.M. McCoy Health Center. There is limited access to public transit in this neighborhood, and many of the residents are elderly or have limited mobility. This further limits their access to proactive, primary care health services.

Columbia is in a growing region of Ohio. The city is home to government offices and several colleges, universities, and technical schools, including the College of Medicine and several schools of nursing. The city hosts a professional hockey team, the Blues, a minor league baseball franchise, and numerous theater, musical, dance, and arts organizations. It is regarded as a community that is economically well diversified and buffered from extreme fluctuations of the state and regional economy.

Nonetheless, almost two-thirds of the residents of this neighborhood have annual incomes of less than 80 percent of the area median of $54,000. One-fourth of the neighborhood arrived in this country in the last five years and are still establishing their families and employment. An estimated 15 percent of the population is over age 65, and approximately one-third of these rely on Social Security and Medicare. The remainder of the low income residents are working in low wage, low skill positions that are often part-time, intermittent, or otherwise do not provide health insurance plans. An estimated 40 percent of this neighborhood does not have access to health insurance. This creates a tremendous need for free primary care throughout the neighborhood.

The three other neighborhood health centers report steady increases in visits and can no longer schedule appointments in less than one week. Even with limited transportation, residents of the Mill Quarter neighborhood accounted for 7.5 percent of neighborhood health center clientele, an increase from 2.5 percent in 2003.

Low income populations and those with inadequate health coverage are more likely to have complications from manageable health conditions such as obesity, high blood pressure, high cholesterol, and sexually transmitted diseases. Simple primary care interventions and education from trusted healthcare providers can significantly reduce the complications of these and other conditions.

Legal and illegal immigration from several countries creates language barriers in providing care, health education, and advocacy to those who need it.

2. Program Description

The health services provided will be extended to all members of the Mill Quarter neighborhood in Columbia, Ohio without consideration of age, race, national origin, religion, family status, or ability to pay. Our outreach and marketing activities will rely heavily on free public announcements in the “What’s Going On?” section of the neighborhood newspaper that is delivered free on Thursdays. The five local churches have agreed to place posters on their bulletin boards. The clergy have been involved in planning the program and are committed to referring individuals in need of the services to the health center. Also, the local welfare office and United Appeal are partnering to provide both funding and information about the available service to their clients. Joe’s Sign Shop is donating a lighted, attractive sign for the front of the building that will make it easy to find the facility.

Volunteers have been recruited from throughout the community, but especially from the medical and nursing schools, local health professionals, and other members of the business community. So far there is a core group of 25 to establish the services and who will assist in continuing recruitment of new and replacement volunteers. Particularly sought after will be volunteers that are multilingual in the several languages used in the neighborhood. Eventually it is hoped that some of those who have been served by the health center will be inspired to “give back” by volunteering themselves, both within the center and by reaching out to their neighbors and friends to encourage good health and nutrition habits.

In kind donations to date have included the sign mentioned above and new and used office equipment and supplies. The building space is being donated by a local property owner, and church groups are assisting with clean up and painting. Local contractors are volunteering their time to plan and supervise needed renovations to the electrical and plumbing systems. The United Appeal, the County Health Department, and All Saint’s Hospital are donating new medical equipment, supplies, medications, and vaccines.

The health center includes a comfortable waiting room outfitted with toys for children, three exam rooms, a private registration booth, a medical records office, secure storage for medications and supplies, separate restrooms for the public and staff, a break area for the volunteers and staff, and a conference/ meeting room for training, educational programs, and private consultations.

When individuals visit the health center they will be greeted by a multilingual volunteer who will help determine the reason for the visit and arrange for them to be seen by a nurse immediately if the need appears to be a possible emergency. In the event of a life threatening emergency, broken bones and the like, the patient will be sent by EMS to the closest emergency room. The center will have only primary care capabilities, the types of services received at a physician’s office: routine physicals, monitoring of chronic conditions, obstetric care, routine lab tests, assistance with smoking cessation, vaccinations, simple suturing, and educational and nutritional counseling. Follow up care will be scheduled. A case management approach will be taken, with a medical professional volunteer making contact with the patient to ensure that missed appointments have been rescheduled and medications are being taken and being well tolerated. Patients will be linked to partner organizations providing assistance with obtaining long-term needs, like medical devices or long-term medications.

3. Mission, Goals, and Objectives

The mission of the J.M. McCoy Health Center is to improve the lives of the residents of the Mill Town neighborhood through better health, healthy habits, and increased connection with the wider community.

The goals for having a community health center in this location are:

1. To make primary health care more accessible to those with limited ability to pay, limited transportation, or language barriers
2. To reduce usage of emergency room facilities for non-emergency health care
3. To reduce the incidence of serious medical problems that result from progression of unattended medical needs
4. To use health education to improve health habits and reduce the incidence of serious medical problems

Some of these goals are more long-term effects of the immediate activity of delivering primary health care and education. But they are the effects that will have long-term major benefits to improve lives. By helping them remain healthier, they will have fewer missed work or school days. They will have reduced stress if work and income are more stable. Education of the young will be enhanced if attendance is better, which will increase chances for better employment and security in their future. Overall medical costs of treating serious medical conditions will be reduced if simpler interventions are taken before those conditions arise. And medical costs can be reduced over the entire health care system if those having little access to primary care are given an affordable alternative to emergency rooms for non-emergency care.

The center plans to start modestly, to use available resources to their maximum benefit, slowly grow the program as outreach efforts are more successful, and demonstrable success attracts more volunteers and funding.

To that end, the first year’s measurable objectives include:

1. To provide primary treatment to 30 patients per day, 5.5 days per week, a total of 8,580 visits per year
2. To provide group health education classes to 10 persons per class, holding 2 classes per month, for a total of 240 attendees per year. Some individuals may avail themselves of more than one class per year.
3. To achieve an increase of childhood immunizations – such that all neighborhood children will be up to date on their immunization schedule by the end of the year
4. To reduce the number of non-emergency visits by Mill Town neighborhood residents to the All Saint’s Hospital emergency room by 2,000 per year (from the current 4,000 per year as tracked by zip code of patient)

The service will be evaluated and monitored through several mechanisms. Volunteers will assist in the gathering of statistics on usage both daily and compiled. Specific services will be tabulated, such as:

• Children immunized at the center
• Patients screened and/or treated for diabetes and high blood pressure
• Referrals to more advanced care
• Flu shots given
• Number served who do not speak English
• Number assisted in smoking cessation/ and smoke free three months later

Along with follow up care, visitors will be asked to mail back comment cards that may be filled out anonymously regarding their satisfaction with the service and how effective they felt their treatment was. There will also be quarterly surveys of the partnering organizations to solicit feedback on their observations of the success of the program based on the experiences of their clientele. The results of surveys and comment cards will be presented in board and staff/volunteer meetings for consideration and discussion as to whether aspects of the service should be adjusted to provide better client confidence and more effective communication and treatment.

4. Organizational Capacity and Qualifications

The Founding Board of the J.M. McCoy Health Center formed over a year ago due to concerns about the health care needs of the Mill Town neighborhood. The center holds a Tax Exempt status under Section 501 (c)(3) of the IRS Code. The Board of Directors now consists of five highly qualified individuals that donate their time to establishing and running the center. Two part-time registered nurses that also have administrative experience serve as the centers chief administrator and assistant manager, with at least one providing coverage during all hours of operation. Volunteer board certified nurse practitioners and physicians provide the actual medical evaluations, treatments, and prescribe any necessary medications. The full résumés of key individuals are available upon request. These key individuals and their roles are as follows:

Board President Harriet Smith, MD, Women’s Health Center

Board Vice-President Harold Smose, MD, All Saint’s Hospital Psychiatry Department

Board Treasurer Harry Jones, CPA, Smith & Jones LLC

Board Member Hazel Thoms, Ph.D., Professor of Foreign Languages, All Saint’s College

Board Member Henrietta Toopes, Owner, Best Ever Cookie Company

Chief Administrator Hubert Underwood, RN, MBA

Assistant Director Hallie Ulrich, RN

5. Budget and Long-Term Sustainability

The capital improvements to the building are nearly complete, and the center should be able to open in six months. These are being donated to the center as “in kind” donations. The budget therefore reflects nearly all operational costs. Only a few pieces of equipment remain to be purchased and will be purchased through a separate capital campaign.

Item	Cost per Unit	Extended Cost for Year
Salaries and Fringes	$60,000 ea	$120,000
Utilities/Telephone/Internet	$1,000 / month	$12,000
Office Supplies	$500 / month	$6,000
Medical Supplies – donated	$1,000 / month	0
Medical Supplies – purchased	$2,000 / month	$24,000
Volunteer Recognition Program	$100 ea	$250
Insurance – property	$1,000	$1,000
Cleaning and Maintenance	$250 / month	$3,000
Total Year		$166,250.00

Revenues to the center will be limited, as most of the expected patients will not have access to health insurance. Medical education classes charge a nominal $5 per class fee, and one partner organization, Mill Town Veterans of American, has pledged to provide ten scholarships each month to those who cannot afford this amount. Total income expected: $1,200 per year. Other pledges for this year include:

• The United Appeal has pledged: $50,000
• The Central Ohio Community Foundation has pledged: $45,000

The Donor Relations Committee, a special committee of five volunteers that isheaded up by one of the board members, is responsible for special fundraising to create an endowment to cover some of the long-term overhead and maintenance expenses of the center. Currently this includes direct appeals to community members and donation boxes that will be distributed to supportive businesses in the community, as well as in the center itself. Though patients will not be charged for services, they will have the opportunity to contribute something anonymously at the donation boxes. Other large fundraisers will be planned, as well as solicitation of legacy gifts (contributions directly from the estates of deceased supporters), as the committee becomes more organized. The plan is to raise $500,000 per year for the next six years, and with cautious investment management, this should generate enough investment income to fund operations at current levels after that time.

The center does not expect to become totally financially independent. There will always be a need for some support from the community and special opportunity grants. The Donor Relations Committee, as well as the board of directors and the executive director, will have responsibility for maintaining relationships with community stakeholders and community connection to and awareness of the beneficial work of the Center.

6. Summary

The J. M. McCoy Health Center fills a substantial gap in the delivery of primary health care in the low income Mill Town neighborhood. With its emphasis on outreach, advocacy, and multilingual capacity, it will gain the trust of those in the community that have been reluctant to seek out health care. The primary health care approach will focus on preventative care, through vaccinations, counseling, and classes that promote better health and nutrition habits. Long term the center will enhance the overall quality of life for the neighborhood residents through better health and affordable care. Area hospitals will have less pressure on their emergency services as individuals seek out primary care at the appropriate level and before deferred issues become medical emergencies.

The health center is already receiving significant community support and should be able to generate some of its own funds in the future, in addition to donations and grants.

The J. M. McCoy Health Center is an excellent match with the interests of the Victor Donald Foundation. The staff and leadership have worked hard to bring the project this far and look forward to being able to start operations with all their planned programming in place with a grant from the Foundation. The Foundation’s consideration is greatly appreciated.

7. Appendices

Copies of Letters of Support

Copies of News Articles and Press Releases