Introduction

This form is intended to help the Community Action network achieve two goals:
  1. Ensure that local initiatives being considered to for highlighting under the COE initiative meet all the required criteria
  2. 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

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* 1. Your Name

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* 2. Your Email

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* 3. Organization Name

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* 4. Is this organization a private (nonprofit) CAA or public (local government entity) CAA?

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* 5. Does this organization currently meet ≥ 90% of the Organizational Standards?

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* 8. Initiative/Project Name

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* 9. Brief description of initiative/project (3-5 sentences)

Required Characteristics

The following areas of the form are required for submission. Please provide a brief description of how the initiative meets this criteria.

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* 10. Local need addressed by initiative

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* 11. Role of CSBG funds in the initiative

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* 12. Describe the initiative’s transformative impact

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* 13. What evidence shows the replicability of the initiative?

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* 14. Describe the evidence base and/or data that show the initiative’s impact

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* 15. Demonstrate that this initiative advances or has the potential to advance equity

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* 16. Describe how customer voice influences the operation of this initiative

Optional Characteristics

Fill 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.

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* 17. Describe how partnerships make this initiative more effective and/or efficient

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* 18. Describe the scalability of this initiative (can it be started on a small scale and grown as resources grow?)

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* 19. What evidence demonstrates the sustainability of this initiative?

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* 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:



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.

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