Mini Grant Demonstration Project: Application for Agricultural Employers

Reducing the impact of COVID-19 on Farmworker Families

Please note: Once you start the application you must complete and submit as there is no option to "save."

Section 1: Contact Information

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* 1. General Information

Name of organization:

Contact person:

Contact phone:

Contact email:

Business address:

Business city:

Business state:

NAICS code classification or agricultural products produced:

Section 2: About your Company and Employees

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* 2. Is your organization part of a farmworker-focused coalition?

Yes

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* 3. If yes, please list and briefly describe the members

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* 4. Number of employees employed annually:

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* 5. What languages do your employees speak? Check all that apply

English

Spanish

Mixtec

Zapotec

Triqui

Mam

K’iche’

Haitian Creole

Nahuatl

Other (please specify)

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* 6. Do you employ workers with an H-2A or TN visa, either directly or through a labor contractor?

Yes

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* 7. (If yes): How many H-2A employees do you employ annually?

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* 8. (If yes): How many TN employees do you employ annually?

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* 9. Do you provide housing for your employees?

No housing provided

Provided for some employees

Provided for all employees

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* 10. Do you provide transportation for your employees?

No transportation provided

Provided for some employees

Provided for all employees

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* 11. Do you have on-farm packing/processing houses or greenhouses?

Yes

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* 12. Do your employees work in other indoor areas for extended periods of time (> 1 hour)?

Yes

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* 13. How many of your employees tested positive for COVID-19 in 2020? (Note: This information will not be shared with any entities outside of the grant evaluation steering committee, and the information will remain confidential.)

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* 14. How many of your employees were hospitalized for COVID-19 in 2020? (Note: This information will not be shared with any entities outside of the grant evaluation steering committee, and the information will remain confidential.)

Section 3: Need and Farmworkers to be served

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* 15. Briefly describe why you feel this project is needed? (200 words or less)

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* 16. Please list each city/ town, ZIP code, or county where most of your work will occur:

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* 17. Select any or all of the populations listed below that will be a primary beneficiary of your project.

Farmworkers

Families of farmworkers

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* 18. How many farmworkers will be served by your project?

Section 4: Proposed Workplan

For your proposed scope of work, check all that apply under each category and answer the relevant questions:

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* 19. Category 1: Vaccination strategies (How do you plan to provide farmworkers access to the vaccine with these funds?)

Will provide education

Will transport workers to a vaccination distribution location

Will have a mobile unit come to the farm (or multiple farms) to provide vaccinations

Will offer the vaccine to employees' household or family members

Other (please specify)

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* 20. Please state how you plan to educate employees about the COVID-19 vaccines and answer their questions before they receive the vaccine. List any relevant partners or resources here. (200 words or less)

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* 21. Please briefly describe your plan for monitoring the health of employees from the time of vaccination until four days post-vaccination, including how the employee would receive medical care if necessary. (200 words or less)

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* 22. Category 2: Prevention and Mitigation Strategies (other than vaccination). How do you plan to support COVID-19 prevention and mitigation efforts?

Provide COVID-19 prevention education (specify in next question)

Purchase face coverings, gloves, hand sanitizer, pulse oximeters, or thermometers

Pay for quarantine/self-isolation housing for positive or exposed workers

Pay for food, health care, or other wrap-around support for positive or exposed workers

Pay for lost wages due to quarantine/self isolation or caring for household members in quarantine/self-isolation

Provide for transportation to COVID-19 testing sites or pay for on-site testing

Pay for COVID-19 tests

Increase sanitation stations

Modify living quarters

Other (please specify)

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* 23. What types of COVID-19 prevention education will you implement? Check all that apply.

Tailgate talks/small group in-person discussions

Video trainings

Text message education

Post flyers/posters

Provide flyers/brochures/other printed materials

Other (please specify)

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Please use the workplan template to complete the required workplan information.

Download the template here

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* 24. Copy and fill in the table to describe project activities, objectives, partners, projected number of farmworkers reached (& family members, if applicable), and key dates. Then be sure to upload the file below.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Section 5: Evaluation

Applicants must commit to completing a report that will include the following based on their scope of project. The report will be due 30 days after the last activity has been completed, or by November 1st, 2021, whichever date is earliest

Report information required, where applicable:

Vaccine Information

Number of employees educated about the COVID-19 vaccinesNumber of employees offered the vaccine
Number of employees who received first/only dose
Number of employees who received second dose on time (where applicable)
Number of employees who received second dose late (where applicable)
Number of family members who received vaccine (where applicable)

Prevention and Mitigation Information

Number of workers receiving general COVID-19 education
Number of care packages with PPE distributed to workers and their families (where applicable)
Number of workers supported through housing for quarantine/ self-isolation
Number of workers receiving assistance for food, health care, or other wrap-around services
Number of workers who lost wages due to quarantine/self isolation or caring for household members in quarantine/self-isolation and the amount of support in funds each worker received
Number of COVID- 19 tests purchased and/or administered
Number of workers provided with transportation to COVID-19 testing sites

Funded organizations will be provided with a template to submit a final report due 30 days after the completion of the project that will include a brief description of project deliverables, impact, collaboration with partners, successes, challenges, and lessons learned.

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* 25. Please indicate your understanding and acceptance of this grant requirement.

Yes, I understand and commit to submitting the required monthly reports and a final report due Nov. 1, 2021.

Section 6: Budget

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* 26. How much money are you applying for? (Up to $100,000. The majority of awards will be $50,000 or less)

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Please use the budget template to complete the required budget information.

Download the budget template here

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* 27. Copy and fill in the budget template and upload the file below.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 28. Project Budget Narrative

In 100 words or less, please describe how you will spend funds listed in the “Other” category, if applicable. Due to federal budget restrictions, mini-grant funds may not be used to buy tobacco, alcohol, food or beverages. Mini-grants also cannot pay for indirect costs.