American Cancer Society, Midwest Division

Community-Based Participatory Research Grants
Letter of Intent (LOI)
  • A Letter of Intent is required for all grant requests prior to submission of a full application
  • Your submission must be received by June 14, 2010, at 4:30pm CDT
  • A confirmation email will follow each Letter of Intent submission
  • Submissions received after the stated deadline will not be considered
  • Letters of Intent will be reviewed by a Review Panel and those that show evidence of merit will be invited to submit a full application for Panel review
  • Questions may be directed to Lindsay Lampi by telephone: (651-255-8158) or email: lindsay.lampi@cancer.org
As a guide to preparing your Letter of Intent, you should bear in mind that the reviewers will evaluate using the criteria and scoring system described below.

REQUIRED ELEMENTS (Reviewers will award up to 70% of the total score to these components)
      a) Description of project with a clear focus on cancer health disparities.
      b) Plans for the collaborative partnership between a community group and an expert or experts familiar with CBPR projects.
      c) Description of plans for evaluation, including, as appropriate, measurable outcomes.

SECONDARY ELEMENTS (Reviewers will award up to 30% of the total score to these components.)
      a) Description of plans for sustaining a project beyond the grant funding period and the potential for a lasting community impact.
      b) Description of opportunities to partner with the American Cancer Society, Midwest Division and, as appropriate, with the State Comprehensive Cancer Control Plan.
      c) Budget must be described.
A. Title of Project
 
B. Contact Information
1. Contact Name
 
2. Name of Organization
 
3. Address (street/city/state/zip)
 
4. Phone Number (with area code)
 
5. Fax Number
6. Email
 
C. Breast Health Priority area (check one)





 
D. If applying as a Community Partner, please provide the following information:
1. Specify the mission and/or goal(s) of your organization.
2. Name the expert partner(s) you will be collaborating with and how they will assist you throughout this project. If your organization needs assistance in selecting an expert partner, what would you expect from this partnership?
If applying as an Expert Partner, please provide the following information:
1. State the mission and/or goal(s) of the community partner you will be partnering with.
2. Explain your expectations for your partnership with the community partner.


E. Explain your affiliation with the American Cancer Society.


F. Provide a brief description of past experience(s) with Community Based Participatory Research, if applicable.


G.

Please provide a brief description of your project and include the following:

▪ how your project will address health disparities

▪ define and explain project goal(s) and objectives

▪ short description of evaluation plan

▪ potential impact on the community


H.

Preliminary Budget Form

▪ Provide estimated costs for each Budget Category

Budget Category

Expense

In-Kind*

Funds Requested

Personnel

   

   


  


  

0.00

Supplies 

   


  


  

0.00

Travel

   

   


 


  

0.00

Indirect Costs

   

   


 


  

0.00

Other

   

   


  


  

0.00

TOTALS
Calculate

 0.00

0.00

0.00



Please note: Since grant funds cannot be used for medical services (screening, diagnostic, treatment), if any of these are included as part of your project, please describe how those expenses will be covered.

For additional items not covered under the grant funds, please refer to the Grant Overview document.

*In-kind support provided by you and/or your partner organization(s).  In-kind would represent any contribution of dollars made to the proposed project by the Grant team. This could include dollars for personnel, materials, services and indirect expenses

                                                                                                                                           

Personnel: Include costs for all applicant organization employees who are involved with the project during the budget period, regardless of whether a salary is requested.  Dollar amounts are calculated based on multiplying the individuals’ institutional base salary by the percent of time devoted to your proposed project.  Include any consultant/collaborator costs.  Likewise, calculate costs for these consultants based on an hourly rate and number of hours to be devoted to your proposed project.

            

Supplies: Itemize supplies into categories such as postage, pens, printing, materials, etc.  Categories in amounts less than $500 do not need to be itemized.


Travel: Local travel is based on the 2010 federal mileage rate of 50.0 cents per mile.  Non-local travel should include the transportation costs from home base to the destination, lodging costs plus any applicable taxes, meals, registration fees and other expenses associated with travel such as parking, car rental or taxis.

Indirect Costs: Indicate costs of general administration, utilities, maintenance of project space and equipment.  Indirect costs can be no more than 20 percent of total budget proposed.

 

Other: Any costs that fall outside of Personnel, Supplies, Travel, and Indirect Costs.

 

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