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Small Grant Guidelines and Instructions for Applicants 2013-2014 The Idaho Affiliate of Susan G. Komen for the Cure® —along with those who generously support us with their talent, time and resources—are working to better the lives of those facing breast cancers in our community. We join more than 100,000 breast cancer survivors and activists around the globe as part of the world’s largest and most progressive grassroots network fighting breast cancer. Through events like the Boise Race for the Cure and the Coeur d’Alene Race for the Cure, we have invested over $5.1 million in local breast health and breast cancer awareness projects in 28 counties. Up to 75 percent of net proceeds generated by the Komen Idaho Affiliate stay in Idaho, the remaining income goes to the national Susan G. Komen for the Cure Research programs for energizing science to find cures. Applications will be accepted for breast health supporting projects relating to education, travel or breast health conferences. Programs must be relevant to our 28 counties in North, Central and Southwest Idaho including, Ada, Adams, Benewah, Blaine, Boise, Bonner, Boundary, Camas, Canyon, Cassia, Clearwater, Elmore, Gem, Gooding, Idaho, Jerome, Kootenai, Latah, Lewis, Lincoln, Minidoka, Nez Perce, Owyhee, Payette, Shoshone, Twin Falls, Valley, and Washington. Important Dates Small Grants Applications are accepted throughout the year. However, requests for support of travel scholarships, conferences, or other events must be received at least six weeks prior to the event. Final written report due 30 days after event/travel concluded. Please explain progress/activities that were made toward reaching the goals/objectives from the original application including the number of people served by Komen grant funding. Eligibility and Funding: Only funding requests which meet the following criteria will be considered for a small grant: Specific to breast health/breast cancer Relevant to the Komen Mission to eradicate breast cancer as a life threatening disease by advancing research, education, screening and treatment. Will the program have a substantial positive impact on breast cancer disparities in the priority area selected Applicant has demonstrated that there is a significant need for this project Willingness to acknowledge support of Komen Idaho Affiliate Activity relevant in the Komen Idaho 28 county service area. Report finances and progress to the Affiliate; final report with receipts much be attached. Allow participation of Affiliate representative where appropriate (education materials, promotional items, and/or guest speakers are available through local Affiliate; other purchases of these items may not be paid with Komen grant.) Not for a fundraising activity Applicants must be a US nonprofit (federally tax-exempt) organization, e.g. nonprofit organizations, educational institutions, government agencies and Indian tribes are eligible. Small grants applicants are restricted a maximum combined award of $5,000 per calendar year, per program, for any type or combination of small grants and/or applicants are limited to two small grant applications per year. Educational Grant Small grants are intended to support some of the “unexpected” costs associated with a project. Funding request for education project must be for $2,500 or less. Allowable Expenses - Funds may be used for the following types of program expenses: Educational materials (please check with Komen for possible educational materials) Meeting Costs (food costs for presentation) Supplies Travel Other direct program expenses Equipment for educational purposes Funds may NOT be used for the following purposes: Salaries and fringe benefits Clinical services or patient care costs (ie. Mammography, ultrasound, etc.) Medical equipment Medical or scientific research Scholarships or fellowships Construction or renovation of facilities Development of materials (design, printing costs, etc.) Political campaigns or lobbying All applications must include all items listed below and should be presented in the same order: 1. Completed application page, (attached) 2. Narrative including the following (2 page maximum): a. Purpose of funding request b. Project goals and objectives c. Benefit to Komen Affiliate d. Timeline e. Other participating sponsors or organizations 3. Detailed budget and budget justification 4. Proof of non-profit status Conference Grant Conference Grants are intended to support local scientific or educational conferences, symposia and meetings, with an emphasis on those that enhance the interaction between the advocate, healthcare and scientific communities. Only funding requests which meet the following criteria will be considered for conference sponsorship, Specific to breast health or to help further the body of knowledge related to research, diagnosis, treatment, education, and/or other issues related to breast cancer Acknowledgement of support from Komen Affiliate in all printed materials (please ask for current logo package before printing) Participation of Affiliate representatives where appropriate Funding request is $2500 or less and cannot be used to fund salaries. Complimentary registration for at least two (2) Affiliate representatives Display area where appropriate Activity report following conference that includes number of participants, copy of conference materials, evaluation of program, and impact of Affiliate sponsorship and participation (due within 20 days of conference) All applications must include all items listed below and should be presented in the same order: 1. Completed application page, (attached) 2. Narrative including the following (2 page maximum): a) Conference program outline b) Target audience and number expected to attend c) Specific sponsorship opportunities (i.e., representation of the Affiliate at events, on panels or as speakers, where appropriate; complementary registration provided for at least two (2) Affiliate representatives; exhibit space in visible, conspicuous location) 3. Proof of non-profit status for applicant institution. To document your federal tax-exempt status, please attach a copy of your determination letter in full from the Internal Revenue Service, must include EIN number. Evidence of state or local exemption will not be accepted. 4. Detailed event budget and budget justification Travel Scholarship The purpose of this funding opportunity is to provide travel assistance to grantees, health care professionals and advocates to attend, participate in, and/or present at meetings, conferences, or symposia that would increase the community knowledge of breast health and breast cancer to facilitate the exchange of ideas and communication between the scientific and lay public. Only funding requests which meet the following criteria will be considered for a travel scholarship: Conference is relevant to breast cancer as demonstrated by agenda, etc. Funding request is less than $1,000 domestic or $2,500 international (to include registration, coach airfare/train/mileage, moderate hotel [room and taxes only], meals, cab fare and tips) Applicant is able to quantify participation and benefit to community Applicant must attend majority of conference and apply for the continuing education credits offered All applications must include the items listed below and should be presented in the same order: 1. Completed application page, (attached) 2. Narrative including the following (2 page maximum): a) Conference goals and/or program outline b) Statement of how program is relevant to breast health c) Specifics of participation and benefit to traveler describing ability and intention of traveler to spread information to Komen Affiliate service area 3. A letters of recommendation, from the employer, if applicable 4. Detailed budget and justification; all receipts must be turned in with detail Questions? Please contact: Susan G. Komen for the Cure, Idaho Affiliate 1409 W. Main, Ste. 120 Boise, ID 83702 (208) 384-0013 [email protected] Application for Small grants: Educational Grants, Conference Grants, and Travel scholarships Idaho Affiliate Small Grant Application Project Director & Title Institute Address Phone ( ) Fax ( ) Email TAX ID NUMBER (EIN) A COPY MUST BE ATTACHED Title of Project/Conference Please attach conference schedule/sessions Total Amount Requested Signature & Title of Approving Personnel (other than Program Director) Name & Title of Approving Institutional Personnel (typed) Educational Grant Date Conference Grant Travel Scholarship Please submit with required documents, no staples. Please allow for a 30 day review period. Final Reports for all Small Grants are due within 30 days of completion of your project. Return info to: 1409 W. Main, Ste. 120 Boise, ID 83702 Fax: 208-384-0014 Email: [email protected]