Project Proposal Template

Organization Name		
Address		
Name of Contact Person		
Title of Contact Person		
E-mail Address		
Daytime Phone Number		
Project Name		
Location of Project		

Project Summary (2 to 4 sentences):

		
Target audience of project (who, what ages)		
# of people potentially reached by project		
Source of this number
(e.g., 2010 US Census data for project location zip code)		

Amount of funds requested (no more than $1,250)

Tobacco-Free Policy

To create the healthiest environment possible, Creating Healthy Places strongly suggests there is a Tobacco-Free Policy passed for the location of the proposed project.  For example, funding is requested for basketball equipment for an outdoor park within a town that has a tobacco-free policy governing all parks and recreation areas within the municipality.

If there is not a Tobacco-Free Policy currently in place, Creating Healthy Places in partnership with the St. Lawrence County Tobacco–Free program strongly suggests the municipality/organization requesting CHP funding commence work toward the adoption of such a policy. Assistance in writing tobacco-free policy is available.

Is there a Tobacco-Free Policy adopted for
the location of the project		
If yes, what year was the policy passed		
Passed by what governing agency
(e.g., Village of      (name)     Board)		

Please provide a copy of the Tobacco-Free Policy

PROJECT DESCRIPTION - Grant objectives and activities must directly support the Creating Healthy Places goal of reducing and preventing chronic illness by creating physical activity opportunities or improving nutritional opportunities across St. Lawrence County.

Provide a description of your proposed project. Include information on:
•	how it addresses the goal of Creating Healthy Places;
•	location of the project;
•	targeted audience(s);
•	need for such a project;
•	other similar resources in the region;
•	possible partnering agencies and the role of each partner, and;
•	efforts already underway regarding this project, if any.

RESULTING GHANGES - Proposed grant projects must demonstrate that implementation of this project will result in environmental, practice and/or policy change(s) at the host facility.

What is an environmental (or facility) change?
A change to the design/built environment to permit the easier performance of an action, course of conduct, etc.
Example: Rental skates are purchased by a recreation department to promote increased skating opportunities for the general public at its ice arena.

What is a practice change?
The integration of changes into the daily routine to result in continued practice of this action.
Example: The new rental skates are made available during increased public skating hours and new “Learn to Skate” classes offered by the recreation department.

What is a policy change?
A major change in attitude, principle, point of view, or practice that is documented in writing and adopted as the regular course of action.
Example: The rental skates, increased public skate times and new Learn to Skate classes are incorporated into the recreation department’s schedule of public programming taught each winter and is documented in writing.

Describe the anticipated environmental, practice or policy changes resulting from the proposed project.

SUSTAINABILITY/MAINTENANCE/SECURITY- Grant objectives and activities must show sustainability. Projects should concentrate on environmental, practice and policy change(s) so in the absence of future Creating Healthy Places funding, the project and resulting changes continue.

Example: A town recreation department establishes a walking/running program that is hosted each summer as part of its regular activities is an example of a possible funding request. A request for funds to host a one-time walkathon would not be granted.

Provide a description of:
•	how your proposed project will be sustained in the absence of future Creating Healthy Places funding;
•	what organization will “adopt” the project as its own;
•	how equipment purchased with grant funding will be maintained and protected from vandalism.

ADDITIONAL SUPPORTING MATERIALS – If available, please provide any additional documents which support your proposal.  The more information that is provided, the stronger your application will be.  Documents could include:
•	Map of proposed project site, e.g. a trail map showing location of fitness stations
•	Letters of support from community groups showing participation/commitment to proposed project
•	Council or Board approval of proposed project
•	Survey results showing need for proposed project
•	Newspaper articles about proposed project, need for project, etc.