Bemidji Area Leaders Acting for Change Mini-Grants
Request for Proposal
RFP Open Date:
RFP Close Date:
Project Name:
Period of Performance:
RFP Number:
Contact Person:
January 31, 2017
March 15, 2017
Bemidji Area Leaders Acting for Change
March 16, 2017 thru August 31, 2017
Tyler LaPlaunt, Program Director
Tyler LaPlaunt
2932 Hwy 47 North / P.O. Box 9
Lac du Flambeau, WI 54538
[email protected]
715.588.1015
This request for applications contains the following information
I. Purpose and Background
II. Funds Available and Anticipated Number of Awards
III. Submission Requirements
IV. Eligibility Requirements
V. Funding Requirements
VI. Proposal Guidelines
VII. Review Process and Awards
VIII. Appendix
I. Purpose and Background
In the fall of 2014, the Great Lakes Inter-Tribal Epidemiology Center (GLITEC) was awarded a
Comprehensive Approach to Good Health and Wellness in Indian Country grant from the
Centers for Disease Control and Prevention (CDC). GLITEC invites Tribes and urban Indian
Programs in the Bemidji Area to submit applications for the Bemidji Area Leaders Acting for
Change (BALAC) mini-grants. The mini-grant program under BALAC is intended to provide
funding to Tribes and urban Indian Programs for implementing policies, system, and
environmental projects related to commercial tobacco-free living, active living and healthy
eating, and evidence-based clinical (preventive) services.
II. Funds Available and Anticipated Number of Awards
GLITEC will provide competitive funding to Tribes and urban Indian Programs, as funding allows,
with a maximum amount per award of $10,000. Each Tribe or organization is limited to one
award. This funding is made available through the BALAC grant through the CDC’s Good Health
and Wellness in Indian Country program.
III. Submission Requirements
If mailed, the application should be postmarked no later than March 11, 2017. The application
may also be emailed, no later than March 14, 2017 to Tyler LaPlaunt.
Email: [email protected]
Address:
Tyler LaPlaunt
GLITC
2932 Hwy 47 North / P.O. Box 9
Lac du Flambeau, WI 54538
IV. Eligibility
Eligibility is limited to federally recognized Tribes located in Michigan, Minnesota, or Wisconsin;
or an urban Indian program located in Chicago, Detroit, Milwaukee, or Minneapolis
Communities currently funded through BALAC or Good Health and Wellness in Indian Country
program are not eligible to apply.
V. FUNDING REQUIREMENTS
Funds may be used for project-related costs including:
-Staff expenses, such as salaries and benefits
-Clerical staff for time directly related to support of the project
-Project support costs (supplies, telephone, space costs, copying and printing, consultant and
contract services, equipment, IDC, programming, etc.)
Funds may not be used for:
-Entertainment
-Lobbying
-Debt reduction
-Capital expenditures
-Illegal activity or activity contrary to Centers for Disease Control and Prevention (CDC) contract
VI. The page limit for the mini-grant applications is five pages, excluding cover page,
appendices, and letters of support.
Proposal Components
Each proposal must contain the following components:
Proposal Contents
A. Table of Contents
B. Narrative
-Not including appendices, the narrative should not exceed five single-sided typed pages
and must be doubled- spaced with 1 inch margins. Use a 12-point type font and number
the pages. Use the section headings throughout the narrative as stated in the instructions.
-Instructions for what to include in each section are provided below. The evaluation
(review) criteria are included to clarify the review process.
The Application Narrative should include:
C. Project Purpose, Goals, and Outcome
-Complete the cover page, located in the appendix and acquire the necessary signature
from the appropriate Tribal/urban Indian Program signing authority.
-The proposed project should be a policy, system, or environmental strategy
-The need for and purpose of the project should be clearly stated.
-Detail any past experience in implementing policy, system, and environmental changes. If
none, describe other applicable experiences.
D. Budget
-Provide a budget covering the time period of the proposed project in table format
accompanied by a simple budget narrative/justification that clearly indicates how the funds
will be spent.
-A sample budget template is attached in the RFP. However, applicants may create their
own budget and budget template.
-Budget definitions and descriptions (for the narrative) are attached in the appendix
documents.
-Budget narrative should be less than one (1) page in length.
Proposal Scoring:
Project Purpose, Goals, and Outcome
Scoring: 90 Points
-The cover page is filled out with the appropriate signing authority (i.e. Tribal Health
Director, Director of the urban Indian organization, Tribal resolution, etc.) (30 points)
-The proposed project is a policy, system, or environmental strategy (10 points)
-Description of why selected area and strategy is a good fit for the focus
community/population (10 points)
-Description of past experience(s) in implementing policy, system, and environmental
changes (10 points)
Budget
Scoring: 10 Points
Expenditures must:
-Be reasonable and clearly related to the project’s goal(s) and activities (5 points)
-Should give justification and further describe of the budget (5 points)
-Be sufficient to support the proposal, yet reasonable to the size, location, and overall
funding capacity of the applicant agency
VII. REVIEW PROCESS AND AWARDS
Any proposal which does not comply with the submission requirements will not be reviewed.
A review panel will consist of individuals having related programmatic experience from the
Great Lakes Inter-Tribal Council and the Great Lakes Inter-Tribal Epidemiology Center.
Each application will be scored and ranked individually by the advisory committee, using the
evaluation criteria described in the proposal guidelines. Funds will be awarded on a rolling
basis until exhausted. Notification of the awards will take place no later than March 16, 2017.
Successful applicants will participate in project and fiscal monitoring activities as defined and
delineated in the contract terms and conditions. Additionally, an agreement outlining the
responsibilities and accountabilities of each partner will be included in the contract.
Appendix
A. Cover Page
This document must be signed by your Tribal signing authority.
B. Budget narrative
Personnel & Fringe Benefits
For each requested position, provide the following information: name of staff member
occupying the position, if available; annual or hourly salary; percentage of time or hours
budgeted for this program; and total salary requested. Also, provide a justification and describe
the scope of responsibility for each position, relating it to the accomplishment of program
objectives. Indicate the fringe rate applicable to each position.
Example:
Jodi Staffperson (1,000 hours @ $25 per hour = $25,000) will provide leadership and
overall direction for the proposed project. She will supervise Samuel Staffperson and
ensure the deliverables are met and the contract is adhered to. Ms. Staffperson’s fringe
benefit rate is 25% per the organization’s policy.
Samuel Staffperson (300 hours @ $18 per hour = $5,400) will provide day to day
management and coordination of the project. This includes coordinating production of
the education and outreach materials, writing newsletter and newspaper articles,
producing the materials, submitting reports, managing funds, planning and
implementing dissemination of the project and materials countywide and planning for
sustainability. Mr. Staffperson’s fringe benefit rate is 25% per the organization’s policy.
Consultants
This category is appropriate when hiring an individual to give professional advice or services
(e.g., training, expert consultant, etc.) for a fee but not as an employee of the Tribal Clinic.
Please provide the following information for consultants:
1. Name of consultant: identify the name of the consultant and describe his or her
qualifications.
2. Organizational affiliation: identify the organization affiliation of the consultant, if
applicable.
3. Nature of services to be rendered: describe in outcome terms the consultation to be
provided including the specific tasks to be completed and specific deliverables.
4. Relevance of service to the project: describe how the consultant services relate to the
accomplishment of specific program objectives.
5. Number of days of consultation: specify the total number of days of consultation.
6. Expected rate of compensation: specify the rate of compensation for the consultant (e.g.,
rate per hour, rate per day). Include a budget showing other costs such as travel, per diem,
and supplies.
7. Method of accountability: describe how the progress and performance of the consultant
will be monitored.
Equipment
Provide complete justification for all requested equipment, including a description of how it will
be used in the program.
Supplies
Individually list each item requested. Show the unit cost of each item, number needed, and total
amount. Provide justification for each item and relate it to specific program objectives.
Travel
Dollars requested in the travel category should be for staff travel only.
Example:
The Project Coordinator will make an estimated 10 trips to local sites to engage
community partners @ average of 20 miles @ $0.55 per mile = $1100.
Other
This category contains items not included in the previous budget categories. Individually list each
item requested and provide appropriate justification related to the program objectives.
A.
Cover Page
Organization Information
Organization Name:
Mailing Address:
City/State/Zip:
Lead Contact Information
Name:
Phone:
Email:
Amount requested:
_______________________________
Tribal Signing Authority
Print name
_________________________________
Tribal Signing Authority
Signature
_________________
Date
_________________
Date
Project Name: __________________________________________
Project Period: _________________________________________
Budget Line Items
Description Detail
Amount
Personnel/Salary
Fringe Benefits
Travel
Supplies
Contractual
Other
Total Project Cost
$
Contractor’s Signature: ___________________________________________________
Printed Name: _________________________________ Title: ___________________
Date: _________________________________________________________________