Grant Applicant’s Letter of Intent Form
Letter of Intent
In 2011 the Caring Community Grants Program of Sequoia Healthcare District (SHD) identified the following as priority outcome areas for the 2012-13 grant cycle: Health Literacy, Food Security, Preventive Health Care, Behavioral Health (for instance, family violence, mental health, substance use) and Chronic Disease Management. Priorities are subject to change annually. SHD’s Information Packet for the Caring Community Grants Program, available from district offices upon request, provided a full description of these outcomes.
All prospective grantees were asked to complete and submit, and all future applicants will be expected to complete and submit, a Letter of Intent to CEO Lee Michelson stating fundamentals of proposed programs for preliminary review. After the District reviews Letters of Intent, applicants moving to the next stage are requested to submit a full application. This process typically begins in early February and takes four to six weeks. Following is the format, subject to change, of the 2012-13 Letter of Intent.
- Name of organization requesting funding:
- Name of program:
- Amount requested for program:
- Is this a new request to SHD, or a renewal?
NEW
RENEWAL
- What is the overallbudget for this program, including other funding sources?
- Is this grant request for your agency alone, or for a collaborative of agencies?
Own agency request
Collaborative request
- Basic description of the program:
- Is this a new program or an existing program?
NEW
EXISTING
- How many District residents will this program serve?
- Approximately how many units of service will each participant receive?
- What evidence do you have that indicates this program is effective?
- Why should the Sequoia Healthcare District fund this program?
Contact:
Lee Michelson, CEO, lmichelson@sequoiahealthcaredistrict.com
525 Veterans Boulevard, Redwood City, CA 94063
Office: 650 421-2155 x 202 Fax: 650 421-2159
