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PurposeThe purpose of the Mission and Ministry Fund (MMF) is to provide funding for new initiatives that impact community health. The violence prevention implementation grant application thoroughly documents and explains the details of the grant proposal. The application includes, but is not limited to, focus areas, baseline measures, goals, metrics, timelines, strategies, planned activities and detailed budget projections. InstructionsOnly Federal Tax-Exempt Catholic Health Initiatives Market-based Organization (MBO), Community Health Service Organization (CHSO), Joint Operating Agreement Organization (JOA), Joint Venture Organization, National Office or Facility are eligible to apply for funding from the Mission and Ministry Fund. For a Catholic Health Initiatives facility, an official letter of support signed by the Regional/Market-based Organization/Community Health Service Organization/Joint Operating Agreement/or Joint Venture Agreement President or Chief Executive Officer is required.For a member from a participating congregation, a letter of support from the major superior of the participating congregation is required stating that the project is part of a sponsored ministry of the congregation.If you checked “Official Catholic Directory (OCD) Exemption,” please provide a copy of the frontispiece where the corporation/congregation is shown in most recent OCD.The completed application must be no longer than eight pages, excluding this instruction page, the cover/signature page, letter of support, proof of tax-exemption and the budget forms. Use U.S. letter page formatting, 12-point font, single spaced and one-inch margins. Do not embed images or file attachments within the narrative application.Appendices and supporting documentation may be submitted but must be no longer than ten pages.Attach the completed budget form and narrative explanation of proposed expenses.Incomplete applications will not be accepted.Submit completed mid-year reports by 5:00pm MTMarch 2, 2020 to MMFGrants@For any feedback or questions related to the Mission and Ministry Fund grant program or questions, please contact MMFGrants@Or Russell Keithline, System Manager – Mission ProjectsRussellKeithline@ | 720-875-7940Cover/Signature PageFacility/Congregation Name and Address:Project Name:Years Requested: ? 1 ? 2 ? 3Amount Requested:Grant Manager: Email:Phone:Eligibility – check the box that applies:? Federal Tax-Exempt Catholic Health Initiatives Organization or Facility ? Official Catholic Directory Exemption? Strategic Partner OrganizationSignature of Market-Based Organization Chief Executive Officer (Community Health Services Organization / Joint Operating Agreement or Joint Venture Organization) or Congregation Leader (Required):Name_________________________________________________Signature_________________________________________________Signature of facility or subsidiary organization leader if applicable, (i.e. foundation leader, hospital CEO, home health agency leader) (Required):Name_________________________________________________Signature_________________________________________________Executive Summary(Please limit Executive Summary to two pages.) Facility/Congregation Name and Address:Project Name:Years Requested: ? 1 ? 2 ? 3Amount Requested:In two pages, briefly describe the following: Please indicate your violence prevention priority area of focus, baseline, goal and timeline. Community-identified Focus Area of Violence:Community/Population:Baseline:Reduction Goal:Time Frame:Long TermShort TermActivities and accomplishments to date of your violence prevention initiative: Implementation action plans and measures for the time period requested: PART I: Implementation Plan Review(You may cut, paste and update the information from your mid-year progress report.) Please provide a summary of the activities, progress and challenges of your violence prevention initiative.Describe any activities, progress or challenges that you faced outside your stated objectives.Part II: Ongoing Implementation Plans:Required Field: Violence Prevention destination goal and metric:Community-identified Focus Area of Violence:Community/Population:Baseline:Reduction Goal:Time Frame:Long TermShort TermPlease describe your planned activities and accomplishments for each specific objective in your violence prevention action plan. Please use the approved action plan and then add any additional objectives/strategies/actions that have been developed as the initiative evolved. What evidence-based or evidence-informed strategies and measures are being used? Please explain significant changes in time frames. Goal:Objectives / Strategies / Actions / Current Status / Time Frame (Include Spectrum of Prevention level addressed)Actions for this funding periodPlease describe the specific role of your organization in the implementation of your violence prevention action plan. How are you monitoring progress and measuring results?Implementation / Process: (Is the strategy being implemented as planned? Is it reaching the intended population?)Impact/ Outcome: (Are the intended outcomes being achieved? What is the change in indicators or violence reduction?) How are you communicating your action plan and results with key stakeholders and the community? Part III: Financial What is the amount requested from Catholic Health Initiatives?What is the total cost of the initiative? Have you approached your organization’s foundation or other in-house funding resource to request funding for this initiative? If not, why? If so, with what results? Please list other funding sources to which you have applied, and amounts awarded from grants, contracts, etc. If you are waiting to hear from other sources, please list them and indicate that they are pending. How will your organization support this initiative?Please describe plans for project sustainability beyond the funding period. How will the project be funded and sustained in the future?List expected in-kind services (rent, administrative support services, existing staff member time, supplies, etc.) What will happen if this initiative is not funded by Catholic Health Initiatives? ................
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