Summer Mini-Grant Survey(s)

1.Reviewer's Name:

2.Scoring Form Questions and Scoring Options (More than Satisfies = 2 Points; Satisfies = 1 Point; Does not Satisfy = 0 Points)

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

Aligns with the goal of enabling individuals with I/DD to live more successfully in the community.

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

Aligns with the goal of making systems change or building better capacity for individuals with I/DD to live more successfully to live in the community.

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

Describes a significant system gap or need which is a barrier to individuals living successfully in the community

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

The number of people with I/DD impacted and/or the amount of impact to individuals with I/DD will make a significant difference based on the amount of funding proposed.

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

Outcomes will have an impact based on the amount of funding requested.

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

The proposal for how outcomes will be demonstrated will show that this project will make a difference for the I/DD Community.

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

The initiative is achievable in the summer months.

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

Funding and match requirements are reasonable and achievable based on the needs of the I/DD community.

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

Overall, the initiative will further the Five-Year State Plan goals of the DD Council.

This application 'more than satisfies the criteria'

This application 'satisfies the criteria'

This application 'does not satisfy the criteria'

3.Comments on Application (Enter Comments Here - Recommendation is Next):

4.REVIEWER'S RECOMMENDATION

I recommend this application for full funding.

I recommend this application for full funding with the following contingencies (NOTE: Put Contingencies in the Contingencies Field Below):

I recommend this application for partial funding (NOTE: Put Recommended Amount in the Contingencies Field):

I recommend this application for partial funding with the following contingencies (NOTE: Put Recommended Amount and Contingencies in Contingencies Field):

I DO NOT recommend this application for funding.

If selected 'Partial Funding' or an option recommending 'Contingencies' - List Partial Funding Amount Recommended and/or Contingencies Here:

5.REVIEWER CONFIRMATION OF SUBMISSION (PRINT NAME)

Summer Mini-Grant Survey(s) - Arts ACCESS

2022 NCCDD Summer Mini-Grant Applicant Organization Name: Arts ACCESS