A. Grant
Application Contents
1. All applications
shall be submitted to the state department by entities as defined in rule
section 1.401(D) in accordance with these rules and shall contain, at a
minimum, the basic program elements specified in section
26.5-3-506(1),
C.R.S., and the following information. A budget which includes each of the
following:
a. Salaries and benefits for the
staff required in rule section 1.407;
b. Costs of the training provided by the
health sciences facility, and costs to cover any other training required by the
health sciences facility. Allowable costs include, but are not limited to,
travel costs and training materials;
c. Costs to purchase and maintain the
management information system and related technical assistance;
d. Operating costs, including, but not
limited to, office and program supplies, postage, telephones, computer(s) with
internet access, liability insurance, medical supplies, mileage reimbursement
and other staff development for the required staff;
e. A description of how the applicant will
fund any additional costs not funded by the grant;
f. Any in-kind contributions the applicant or
other stakeholders in the community may donate.
2. Applications for New Entities
In addition to the requirements of rule section 1.402(A)(1),
applications for new entities shall contain, at a minimum, the following
information:
a. A description of the
experience the applicant has working with the target population and existing
home visitation programs;
b. A
description of the community support for the program and for the applicant as
the lead organization in its implementation, including detailed information
about the broad-based support for the program's implementation. Breadth of
community support shall be judged by the diversity of those involved in
supporting the program's implementation, and can be evidenced through letters
of support and more formal referral relationships among various community
organizations and the applicant;
c.
A description of the specific needs of the population to be served including,
but not limited to, the socio-demographic and health characteristics that
justify the need for the program and the number of first-time, low-income
mothers eligible for the program;
d. A description of the relationship of the
applicant with the schools, prenatal clinics and other referral sources for the
first-time, low-income mothers who will be served by the program, with specific
information about the duration of these relationships;
e. A description of the nature and duration
of the referral linkages that exist between the applicant and other service
providers throughout the community including, but not limited to, providers of
social services, mental health services, workforce preparation services, job
training services, legal services, health care services and child care
services;
f. Except as provided in
rule section 1.409, a description of a plan for recruiting at least one hundred
(100) first-time, low-income mothers;
g. A description of the collaboration between
the applicant and other entities providing similar services to the same
population, including plans for coordination and a description of how the
program will fit in with and complement the community's efforts to meet the
needs of the target population, if applicable;
h. A plan for hiring and retaining qualified
staff that represents the community's racial and cultural diversity;
i. A description of the applicant's capacity
to comply with and monitor the implementation of the grant
requirements;
j. Summary of the
major strengths of the applicant and the community that will lead to successful
implementation of the program;
k. A
statement as to whether the applicant plans to work collaboratively with other
entities in either administering the program or through an oversight board, and
whether the other entities are other counties, municipalities, agencies, or
organizations; and
l. If an
applicant currently provides services in compliance with rule sections 1.406
through 1.409, using funding other than from the Nurse Home Visitor Program
Fund, the applicant shall state if:
1) The
applicant expects to continue to receive funding from such alternative funding
source; and
2) Funds received
pursuant to these rules will be used to increase the number of clients served.
3. Applications
for Multiple Community Collaboration
If multiple communities with lower birth rates need to
collaborate to meet the one hundred (100) family requirement, the applicant
shall provide specific plans that address the mechanisms and history of the
collaboration in addition to complying with the requirements of rule sections
1.402(A)(1) and (2). The plan shall include, but not be limited to, examples of
previous collaborations.
4.
Applications for Expansion Sites
In addition to complying with the requirements of rule
section 1.402(A)(1), each expansion site shall submit the following in its
application:
a. Confirmation that the
entity has implemented the program in compliance with these rules;
b. A description of additional community
demand for the program that is not being met through the current
funding;
c. A specific plan for
building additional infrastructure to support the expansion of the program
including, but not limited to, physical space, staff supervision, and computer
data entry personnel;
d. A
description of how the implementing entity has addressed previous specific
challenges relating to the program;
e. A plan describing the implementing
entity's strategy to recruit and train sufficient qualified nurses to implement
and expand the program; and
f. A
description of community support for the planned expansion of the program.