Large Grant Application: $25,001 or more
Thank you for your interest in the Partners for Healthy Kids Grant. Please complete all sections. Any additional supporting documentation, supplements, etc. can be uploaded at the end of the application. Please contact Annie McDaniels at annemarie.mcdaniels@wayzataschools.org with any questions.
Section One - General Information
Organization
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Contact Person
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First Name
Last Name
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Section Two - Project Details
Project Title
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Is this a Wayzata Public Schools grant application?
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Yes
No
Number of Years the Program/Project Has Been in Operation
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Number of Years Previously Funded
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Amount Requested
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If less than $25,000, please use the other grant application which aligns to the amount requested.
Total number of Wayzata Students Projected to be Served considering only the PHK funds requested.
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The number of Wayzata students in this field is the number served by only the funds requested.
Total number of Wayzata Students Projected to be Served with Requested PHK Grant Funding plus additional funding from other sources.
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The number of Wayzata students served provided in this field is the total amount overall, including other sources of funding like 3rd party billing, other grant awards, etc.
Project Start Date
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Month
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Day
Year
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Project End Date
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Month
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Day
Year
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Please describe your project, including the evidence of need , who will be served, what services or activities will be provided, and how the project will be implemented.
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How will the proposed project/programming benefit the children and families in the Wayzata School District community?
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Please describe the project's goal(s). Clearly state each specific goal, the way(s) in which you will meet the goal(s) and the expected outcomes resulting from this program/project.
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All funded projects MUST capture measurable data. Explain how the progress and goals will be measured. Please specify which scales/tools are used to evaluate and measure outcomes and goals.
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Please describe your criteria for evaluating success. Who will be involved in evaluating this work (staff, board, participants, etc.)? What will you do with your evaluation results?
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The Minnesota Department of Human Services has established the three statewide collaborative priorities listed below. Please select the one that best fits your program.
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Promote mental health & well-being of children, youth & young adults
Support healthy growth & social emotional development of children, youth & young adults
Strengthen resilience & protective factors of families, schools & communities
None of the above
In addition to statewide priorities, we have developed local priorities with our mission of working "to improve the social, emotional, educational, and economic outcomes of children and families in our community." Please select which of our current priorities best fits your program.
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Early Childhood: Access to high quality early childhood care, family support and parent education for low-income families.
Mental Health: Intervention and early identification services for students E-Transition who are at risk of mental/chemical health issues, utilizing school linked mental health programs.
Positive Youth Development: In/out of school time, including summer programs.
None of the above
Does your program provide any of the following? (Check all that apply)
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Coordinated outreach to children & families in need of services
Coordinated early identification of children & families in need of services
Coordinated services & interventions across service systems
Coordinated transportation services
Initial outreach to all new students
Periodic family visits to children who are potentially at risk
Coordinated assessment across systems to determine which children & families need coordinated multi-agency services & supplemental services
Wraparound process
Multi-agency service plans or multi-agency plan of care
Coordinated unitary or integrated case management
Integrated funding of services
Strong collaboration between parents & professionals in identifying children in the target population, facilitating access to the integrated system & coordinating care & services for these children
Individualized children mental health rehabilitation services
None of the above
Who do you plan to serve? (select all that apply)
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Children ages 0-5
Elementary school students
Middle school students
High school students
Students and families
What are the criteria for service? (select all that apply)
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Free/reduced lunch
Behavioral referrals
Mental health factors
School related factors
Family related factors
Recent immigrants
Attendance
Test Scores
Other
Other Criteria for Services
What data sources are used to assess local needs or priorities? Please check all that apply.
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Census Data (Including ethnic/racial data)
Child Protection Reports
Community Action Program (CAP) Surveys
Community Health Needs Assessments
County Children's Mental Health Gaps Analysis
Minnesota Student Survey (including ACEs info re risk & protective factors)
Substance Use Data
Local Data (please specify under "Other" field)
Other Data (please specify under "Other" field)
Other Data Sources
Which organizations do you partner with in order to fulfill these needs and goals? Please list the organization(s), your plan(s) for collaboration and how many year(s) you've collaborated.
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If there is a new collaboration, please specify the new partnership. Collaboration can be financially, in-kind or both.
Does your program address Adverse Childhood Experiences (ACEs)? Please describe how they're addressed and what outcomes you have seen and/or your outcome goals.
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Do you anticipate any changes in the coming year which would impact your ability to provide services as you currently do? Please describe any potential community/economic/etc. changes that may affect your programming.
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Section Three - Budget Form, Details and Other Supporting Documentation
Please complete this Budget Form and upload below
Upload the completed Budget form outlining the total budget for the program.
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Completed Budget Form
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Please use this section to expand on the Budget Form information by sharing additional detail or context about your program’s budget, including how requested PHK funds would be used and what other funding sources support the program.
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e.g., If "supplies" are being purchased, please provide details about said supplies. For any line items that require spreadsheets or invoices, those files can be uploaded at the end of the application.
Other funding sources accessed (source and amount) applied to this project
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Can be financial and/or in-kind.
Should the grant funding not be approved, either fully or partially, how would you make up for this shortfall?
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The LCTS dollars which fund these grants are not guaranteed. Should these funds become unavailable in the future, please describe the sustainability plan for this project/program.
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Do you have a minimum of $1 million liability insurance coverage?
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Yes
No
Please share additional comments or considerations you would like us to know that weren't already addressed on the application.
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