39-3205. APPLICATION REQUIRED. (1) A completed community health center grant application must be submitted by the applicant for the purpose of requesting a grant on or before the conclusion of the application period specified for the appropriate grant cycle.

(2) Each application shall include:

(a) Identification of geographical area to be served;

(b) Individual or entity requesting funds;

(c) Narrative description of the community health needs and the methods to be used to address such needs and demonstrate the potential of the project to improve patient health outcomes and access to health care services in the community;

(d) Identification of measurable goals, objectives and patient health outcomes to be used to reach the goals, and the resources necessary to complete each activity;

(e) Estimation of how long it will take to accomplish the individual activities of the project;

(f) Demonstrated community support for the project;

(g) Proposed project budget including:

(i) A line item budget with a brief description of each expense category, including any anticipated operating expenses, capital and equipment or contract expenses;

(ii) Documentation of one (1) or more vendor price quotes for all proposed equipment purchases;

(iii) Contact person for verification of fiscal information; and

(h) Federal tax identification number.

(3) All applications must include the required information.

(4) The grant application and any attachments submitted by the applicant shall be the primary source of information for awarding a grant.

History:

[39-3205, added 2007, ch. 199, sec. 1, p. 606.]