March of Dimes Community Grant Letter of Intent

2013 Letter of Intent Application

If your agency has participated in the Tennessee March of Dimes Mandatory Statewide Conference Call, you are eligible to complete this Letter of Intent Application. Please adhere to the information provided on the call and available on our website at marchofdimes.com/tennessee.

Please familiarize yourself with the questions and create your responses in a separate document. You should perform a word count (maximum of 5000 characters) and then cut and paste your information into the available fields.

Letters of Intent must be submitted by 4:30pm CST on July 12, 2013. You will receive a confirmation email (it is not automatic, so it will not be sent immediately after submission).

If you have any questions, please contact:
WEST TENNESSEE: Valencia Nelson, 901-800-0343, vnelson@marchofdimes.com
MIDDLE & EAST TENNESSEE: Tamara Currin, 615-800-7181, tcurrin@marchofdimes.com

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* 1. Please list your name and job title within your organization.

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* 2. Please provide your email address.

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* 3. Please list your organization's name and address.

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* 4. Which of the funding priorities is the project addressing?

Providing or enhancing preconception health/interconception education and/or services.

Providing or enhancing premature birth risk reduction education and/or services.

Enhancing care through the CenteringPregnancy® model of group prenatal care.

PLEASE INCLUDE A FOCUS AREA FROM ONE OF THE THREE FUNDING PRIORITIES (bulleted items i.e. diabetes, tobacco use, alcohol, etc). For Centering Pregnancy, please add CP unless there is an additional focus.

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* 5. Who is the target audience?

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* 6. How many people will the project reach?

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* 7. What are the measurable objectives?

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* 8. How will project success be evaluated?

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* 9. What impact will the project have?

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* 10. What is the amount of funding requested? Please include major budget
categories and allocations for each.

Question Title

* 1. Please list your name and job title within your organization.

Question Title

* 2. Please provide your email address.

Question Title

* 3. Please list your organization's name and address.

Question Title

* 4. Which of the funding priorities is the project addressing?

Question Title

* 5. Who is the target audience?

Question Title

* 6. How many people will the project reach?

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* 7. What are the measurable objectives?

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* 8. How will project success be evaluated?

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* 9. What impact will the project have?

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* 10. What is the amount of funding requested? Please include major budgetcategories and allocations for each.

* 10. What is the amount of funding requested? Please include major budget
categories and allocations for each.