Center of Excellence Highlighted Initiative Form Introduction This form is intended to help the Community Action network achieve two goals: Ensure that local initiatives being considered to for highlighting under the COE initiative meet all the required criteria Permit those reviewing highlighted initiatives to consider common aspects of each one relative to another for easier comparison and analysis Please refer to the selection criteria to ensure responses address the specific requirements of the COE initiative.Please complete this form for each separate initiative. It is designed so you can easily copy/paste from the Word document version. Organization Info Question Title * 1. Your Name Question Title * 2. Your Email Question Title * 3. Organization Name Question Title * 4. Is this organization a private (nonprofit) CAA or public (local government entity) CAA? Private/Nonprofit Public Hybrid Question Title * 5. Does this organization currently meet ≥ 90% of the Organizational Standards? Yes No Question Title * 6. State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY Question Title * 7. Region Region 1 Region 2 Region 3 Region 4A Region 4B Region 5 Region 6 Region 7 Region 8 Region 9 Region 10 Question Title * 8. Initiative/Project Name Question Title * 9. Brief description of initiative/project (3-5 sentences) Required CharacteristicsThe following areas of the form are required for submission. Please provide a brief description of how the initiative meets this criteria. Question Title * 10. Local need addressed by initiative Question Title * 11. Role of CSBG funds in the initiative Question Title * 12. Describe the initiative’s transformative impact Question Title * 13. What evidence shows the replicability of the initiative? Question Title * 14. Describe the evidence base and/or data that show the initiative’s impact Question Title * 15. Demonstrate that this initiative advances or has the potential to advance equity Question Title * 16. Describe how customer voice influences the operation of this initiative Optional CharacteristicsFill out the following only as it applies or as requested by the RPIC. Please provide a brief description of how the initiative meets this optional criteria. Question Title * 17. Describe how partnerships make this initiative more effective and/or efficient Question Title * 18. Describe the scalability of this initiative (can it be started on a small scale and grown as resources grow?) Question Title * 19. What evidence demonstrates the sustainability of this initiative? Question Title * 20. What are the primary funding sources for this initiative? (specific budget information is not required) Thank you! If you have any questions or concerns, please contact our Training & Technical Assistance Team: Aaron Wicks, Vice President of Organizational Capacity Building (awicks@communityactionpartnership.com) Maribeth Schneber-Rhemrev, Director of Organizational Capacity Building (mschneberrhemrev@communityactionpartnership.com) Tayla Daniel, Program Associate of T/TA (tdaniel@communityactionpartnership.com) This resource was created by the National Association of Community Action Agencies – Community Action Partnership, in the performance of the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Community Services Grant Number, 90ET0469. Any opinion, findings, and conclusions, or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the U.S. Department of Health and Human Services, Administration for Children and Families. Done