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SHIP Neighborhood Mini-Grant Application 2021

2. SHIP Neighborhood Mini-Grant Application 2021
   Prior to completing this application, please review the Anoka County SHIP Neighborhood Mini-Grant Instructions. Any questions about the application can be sent to SHIP@co.anoka.mn.us

   Prior to completing this application, please review the Anoka County SHIP Neighborhood Mini-Grant Instructions. Any questions about the application can be sent to [email protected]

4. Anoka County SHIP Neighborhood Mini-Grant Instructions
   View instructions here

8. Organization / Group Information

10. Today's Date*

11. Organization/Group Name*

13. Organization/Group Address*

15. Approximate number of community or group members that would be impacted by this project*

16. Name of Primary Contact*

18. Phone Number of Primary Contact*

19. Email Address of Primary Contact*

21. Give a brief explanation/background of your organization/group.*

25. Project Information

27. Project Goal(s)*

    What are the goals of the project? Project goals must contribute to one of the three Top Areas listed in the Instructions sheet.

29. Description*

    Provide a general description of the project and please include an explanation for why the project is needed. Please list any other organizations or partnerships that may be involved in this project (if applicable).

31. Health Equity*

    Please describe how this project is increasing opportunities that would not otherwise be available or accessible to this population.

35. Action Plan and Timeline
    List the activities needed to accomplish the project and the timeline for completing them. Add more lines as needed.

    List the activities needed to accomplish the project and the timeline for completing them. Add more lines as needed.

37. Action Plan/Activities

38. Timeline

40. Action Plan/Activities

41. Timeline

43. Action Plan/Activities

44. Timeline

46. Action Plan/Activities

47. Timeline

49. Action Plan / Activities

50. Timeline

52. Action Plan / Activities

53. Timeline

55. Action Plan / Activities

56. Timeline

58. Action Plan / Activities

59. Timeline

61. Feel free to attach a document with more lines as needed.

65. Budget
    Include all projected budget items, such as equipment, materials, training fees, printing, etc. Add more lines as needed. Please include links to specific items as needed. All approved and agreed upon items will be purchased directly by Anoka County SHIP.*

    Include all projected budget items, such as equipment, materials, training fees, printing, etc. Add more lines as needed. Please include links to specific items as needed. All approved and agreed upon items will be purchased directly by Anoka County SHIP.*

67. Budget Item

68. Brief Description

69. Cost ($)

70. In-Kind Contribution/Description

72. Budget Item

73. Brief Description

74. Cost ($)

75. In-Kind Contribution / Description

77. Budget Item

78. Brief Description

79. Cost ($)

80. In-Kind Contribution / Description

82. Feel free to attach a document with more lines as needed.

83. Total Amount Requested:*

85. * SHIP funding cannot be used for labor/installation costs, alcohol/illegal substances, capital improvements, clothing, lobbying, fitness center memberships, raffles, etc. Approval of items is determined by the MDH SHIP Financial Guidance and Anoka County SHIP discretion.

87. Ship requires all projects to include evaluation. Are you willing to work with SHIP staff to come up with an evaluation plan?*

    1. Yes
    2. No

88. Evaluation Plan*

    What would indicate to you that this project was successful?

90. Sustainability*

    What is the plan for making sure the project continues after funding ends?

91. Communications*

    Who needs to know about this project - community members, community leaders, etc? How will you communicate with these groups?

95. By signing the Project Application, you agree:

    (no need to check these boxes)

    1. The project is located in Anoka County, MN.
    2. To provide updates on project status, including (but not limited to) timelines, budget spent, and activities, as requested within 5-10 business days.
    3. To conduct evaluation activities and provide any data that was collected. SHIP staff isavailable to assist with the evaluation process including development and data collection.
    4. To submit success stories, which can include photos, quotes, video, etc. highlighting your project.
    5. To communicate with Anoka County SHIP on a regular basis throughout the grant cycle to provide updates, including at least one success story at the end of the mini-grant period.
97. Signature*

    Type your name to confirm you've read and agree to the requirements.

98. Date*
    Date

Leave This Blank:


100. 1. Receive an email copy of this form.
101. Email address

     This field is not part of the form submission.

102. Submit

* indicates a required field