H1N1 Preparedness Grant Application
H1N1 Preparedness Grant Application
West Virginia Higher Education Policy Commission
Office of the Vice Chancellor for Health Sciences
1018 Kanawha Boulevard East, Suite 700
Charleston, WV 25301
Deadline for Applications: November 13, 2009
Grantee Organization:
FEIN:
State Vendor No.:
Mailing Address:
Project: H1N1 Preparedness Program
Requested Amount:
Performance Period: August 1, 2009 through July 30, 2010
Chief Executive Officer and Title:
Mailing Address:
Phone Number: Fax Number:
Email:
Contact for Project and Title:
Phone Number: Fax Number:
Email:
Project Description: Briefly describe the H1N1 planning and response goals, objectives, and activities, including the target population (s) to be served through requested grant funds. Include information on the campus locations to be served.
Outcomes: List the actual impacts/benefits anticipated as a result of this project, and how you will measure progress in reaching these outcomes.
Outcome Performance Measure
1. 1.
2. 2.
3. 3.
Implementation Plan: List the phases of project implementation and related activities, including the target dates.
Activity Time Frame
1. 1.
2. 2.
3. 3.
Coordination with Local Health Department and other Community Partners: Describe your approaches with the local health department and other community partners to plan and coordinate H1N1 preparedness activities.
Project Budget
Grantee Name:
Preparer’s Name and Title:
Period Covered: August 1, 2009 – July 30, 2009
A. Personnel:
% Time
Position Salary/Rate on Grant Total Cost
B. Fringe Benefits:
Component Base Rate Total Cost
C. Equipment:
% Paid
Item Item Cost by Grant Total Cost
D. Supplies:
Item Number Price Total Cost
E. Contractual Cost:
Position Service Salary/Rate Total Cost
(Continued next page)
F. Other Expenses (for example, support for planning meetings, public education and communication strategies, etc.):
Item Total Cost
G. Indirect Administrative Costs (must not exceed 8% of Direct Costs)
Formula
Indirect
Base (Total Direct costs) Rate (%) Costs
* * * * * * * * * *
Total Direct Costs (Items A through F): _____________________
Total Indirect Costs (Item G): _____________________
TOTAL GRANT AWARD: _____________________
Grantee Preparer’s Signature Date
For the WV Higher Education Policy Commission Date
APPLICATIONS ARE TO BE SUBMITTED ELECTRONICALLY BY 5:00 P.M.
ON NOVEMBER 13, 2009
E-mailed: bowe@hepc.wvnet.edu
One signed hard copy also needs to be mailed to:
WV Higher Education Policy Commission / Office of Health Sciences
1018 Kanawha Boulevard, East; Suite 700; Charleston, WV 25301
Questions: Contact Becky King, H1N1 Coordinator
E-mail: bk0517@
Phone: 304-757-9456
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- welcome to charleston west virginia
- west virginia department of arts culture and history
- scholarships are in order by deadline
- cfwv connect an interactive toolkit to assist counselors
- h1n1 preparedness grant application
- undergraduate research opportunities
- introduction west virginia office of education
- curriculum west virginia university
- static
- west virginia literacy foundation
Related searches
- free pell grant application fafsa
- pell grant application form
- target community grant application form
- federal pell grant application online
- pell grant application 2019
- target foundation grant application form
- pell grant application form printable
- pell grant application 2019 2020
- wells fargo grant application form
- pell grant application 2020 2021
- government pell grant application online
- federal pell grant application form