2019-2020 Grant Letter of Inquiry

 

2019-2020 Letter of Inquiry Cover Sheet

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Question - Required - Please check type of application (multiple areas can be selected):
Please make between 1 and 2 selections from the choices below.

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Description of Request:  Attach a brief description answering the questions below.

  1. Statement of need:  Describe the community/populations to be served by this program, key health disparities, and their breast health/breast cancer needs. (Define the problem)
  2. Program description: Describe the goals and objectives of the program, including key activities you wish to implement in order to address the problem you identified above. Describe how the funds will be used to implement your program and the approximate number of people you hope to reach (if possible, include the number of people served per activity).Briefly explain why you believe your proposed services/activities/strategies are culturally sensitive/effective for the target population(s) and/or geographic area(s) to be served. Where possible, please include information on how your program addresses key findings outlined in the 2015 Community Profile Report. (Describe your solution).
  3. Additional information requested: Describe your efforts to reach out to individuals who have never been screened or not screened in a long time (3-5 years or more), as well as how you will work to ensure treatment continuation and follow-up; include a description of how you will link patients to services across the continuum of care and who you will partner with for screening and/or diagnostic and treatment services. In addition, indicate how can Komen Puget Sound best support your program as it relates to our priority populations and geographic areas?
  4. Partnerships: List organizations you will partner with and their roles on this project.

For additional information please visit: http://komenpugetsound.org/about-us/history/our-community-need/.

 

Organizational Capacity Information

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After submitting your LOI online, please submit copies of the following documents postmarked September 28, 2018:

  • Proof of exempt status (if you are a new applicant)
  • Most recent financial statements (year-end income statement and balance sheet), audited if available.
  • Organization budget for current year, including income and expenses.

Mailing Address:

Komen Puget Sound
Attn: Robyn Sneeringer, Director of Programs
112 Fifth Avenue North
Seattle, WA 98109

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