FY21 FDPNE Application Template.docx

SECTION 1: Cover Sheet - Applicant Information (one page)

Food Distribution Program Nutrition Education (FDPNE) Grant Application - Fiscal Year 2021

CFDA#: 10.594

Organization Name:

Organization Address:

Name of Contact Person and Title:

Project Director:

Name of Authorizing Official:

Email Address:

Phone Number:

Section 2: Table of Contents (one page)

Organization Information

Page #

Application Project Summary

Page #

Project Goals

Page #

Project Activities and Timeline

Page #

Progress and Success Monitoring Chart

Page #

SECTION 3: Organization Information (two pages)

Instructions: Use the space below to describe your organization. Providing a list or a narrative statement is acceptable. Include the following:

· Administrative structure of the organization and FDPIR. (You may submit the same background information included in your FDPIR Plan of Operation.)

· Unique features of the Reservation or geographic location. (You may submit the same background information included in your FDPIR Plan of Operation.)

· Average number of FDPIR households served per month and average number of FDPIR participants served per month.

· Brief description of current or past nutrition education efforts as well as any resources available and partnerships. If you are a prior FDPNE grant recipient please include examples of past nutrition education efforts completed with FDPNE funds.

SECTION 4: Project Goal(s) (two pages)

Instructions: You must select one (or more) goals from the list below (#1-4). For each goal selected, you must also designate one (or more) nutrition-related outcomes (letters a-d) you hope to achieve with your project. Place an X on the line(s) below to select your goal(s) and outcome(s). In addition, if applicable, indicate your partner organization(s).

1) Create and/or disseminate culturally relevant nutrition education resources (posters, handouts, videos, cookbooks) that encourage participants to work towards one or more of the nutrition-related outcomes:

a. Make half your plate fruits and vegetables. Focus on whole fruits and vary your veggies.

b. Reduce sodium intake.

c. Make half your grains whole grains.

d. Move to fat-free or low-fat dairy products.

2) Conduct community outreach (healthy cooking demo, nutrition education games, and nutrition handouts, healthy recipe distribution) at community events, health fairs, gatherings, and/or celebrations that promotes one or more of the following nutrition-related outcomes among FDPIR eligible participants:

a. Make half your plate fruits and vegetables. Focus on whole fruits and vary your veggies.

b. Reduce sodium intake.

c. Make half your grains whole grains.

d. Move to fat-free or low-fat dairy products.

3) Improve nutrition-related skills among FDPIR participants by conducting healthy cooking and food demonstrations and/or nutrition and wellness classes or activities demonstrating the utilization of foods included in the USDA FDPIR food package to accomplish one or more of the following nutrition-related outcomes:

a. Make half your plate fruits and vegetables. Focus on whole fruits and vary your veggies.

b. Reduce sodium intake.

c. Make half your grains whole grains.

d. Move to fat-free or low-fat dairy products.

4) Develop and/or implement community tribal wellness policies or practices at community events, gatherings, and celebrations that reinforce one or more of the following nutrition-related outcomes.

a. Make half your plate fruits and vegetables. Focus on whole fruits and vary your veggies.

b. Reduce sodium intake.

c. Make half your grains whole grains.

d. Move to fat-free or low-fat dairy products.

Project Partner (name, location, and a brief description), if applicable:

SECTION 5: Application Project Summary (two pages)

Instructions: Use the space below to provide a summary of the project. The following information must be included.

· What are you hoping to achieve by conducting this project?

· Provide a high level summary of the activities you will conduct and how the activities will help you achieve your selected goal(s).

· The number of participants you will reach with your project, and the results you expect.

· Designate a Project Director/Coordinator. Write the name of that person, or indicate that you intend to hire a person to fulfill this position. It is recommended that a Project Director contribute a minimum of 25% time to oversee complex projects.

· Provide a list of staff that will work on the project and explain their responsibilities.

· Target Audience: Provide brief details about who will benefit from your nutrition education activities. For example, FDPIR participants or those eligible, reservations they reside on, their ages and gender, and other program sites where recruitment will occur.

· Document how activities may continue after the funding period ends.

· List all organizations, agencies, or individuals who will provide or assist with nutrition education or nutrition services and describe the assistance they will provide.

· If the applicant is a consortium, identify the member organizations of the consortium. Attach Memoranda of Agreements from all participating FDPIR programs.

· Written agreements. Describe agreements and collaborations with sub-grantees and other programs or organizations. Attach Memoranda of Agreements or letters of support/commitment with sub-grantees and partners and submit with your application. Sub-grantees must sign an agreement with the FDPIR allowance holder that documents programmatic and fiscal agreement between the FDPIR allowance holder and the sub-grantee. Submit the agreement with your application.

Note: Written agreements do not count toward the 2 page project summary limit.

SECTION 6: Project Activities and Timeline (two pages)

SECTION 7: Project Evaluation Plan (one page)

Instructions: Choose the methods you will use to evaluate the progress and success of your FY21 nutrition education project. You are required to select at least 2 methods. The methods listed in the table below are intended as examples of approaches you might use to monitor your project’s progress and success. You can add any additional methods you propose below.

Examples include: recording the number of participants who attend a nutrition education class, documenting the number of participants who receive nutrition education handouts, or comparing the knowledge gained by participants after they have taken a class to what they knew before.

Participant feedback surveys

Results of knowledge assessments administered before and after educational sessions, topic of assessments, number of persons who will complete an assessment

Number of participants who attended nutrition education session (sign-in sheets)

Number of participants who attended food demonstration/cooking class (sign-in sheets)

Photos or videos

Number of community outreach events, gatherings, or celebrations that implemented a tribal wellness or nutrition policy

Qualitative Feedback monitoring (what are director’s hearing from participants regarding the nutrition education offered and how is this feedback being documented)

[insert additional method here]

[insert additional method here]

SECTION 8: Budget Narrative (six pages)

Instructions: You must use the format below. Use the categories and columns that are relevant for your budget request. Be sure to explain how you calculated each cost and the reason each expense is necessary in the Narrative/Justification column. All dollar amounts should be rounded up to the nearest whole dollar.

Reminders:

· Provide cost breakdowns for each line item in the Narrative/Justification column such that the expected cost of each item is listed. For example, the total cost of office supplies should include prices for specific items (e.g., pens, pencils, ink, etc.).

· When calculating the cost for food, and materials for cooking demos and nutrition education activities, applicants should use the expected number of participants at the nutrition education activities, not the total number of FDPIR participants.

A. Personnel Please use the format provided below to list all personnel to be funded by this grant. You may insert additional rows as needed.

Note: FTE stands for Full-Time Equivalent, which represents what a person would be paid for full-time employment.

A1. [Insert Title Here], at X% FTE, salary $XX,XXX per yr

[Insert job duties and responsibilities here]

A2. [Insert Title Here], at X% FTE, salary $XX,XXX per yr

[Insert job duties and responsibilities here]

Personnel Subtotal

B. Fringe Benefits Provide the Fringe Benefits cost for all personnel listed in Section A. You may insert additional rows as needed.

Organization Fringe Benefit Rate:__ __

B1. Personnel A1 Fringe Benefits

[List benefits covered]

B2. Personnel A2 Fringe Benefits

[List benefits covered]

Fringe Benefits Subtotal

C. Contractual For all contract work, provide the number of hours the contract is expected to take as well as the anticipated hourly rate (e.g., # hrs. at $XXX per hour).

C1. [Insert Service/Personnel Here]

[provide a justification for why this service is justified; explain rationale for estimated cost]

C2. [Insert Service/Personnel Here]

[provide a justification for why this service is justified; explain rationale for estimated cost]

Contractual Subtotal

Amount of Contractual Not Subject to Indirect Costs

Are there indirect costs associated with any of the proposed contractual costs? [Yes/No]

If yes, provide the total amount of indirect costs associated with contracts in the space below.

D. Travel For all travel, include origin and destination information as well as the anticipated dates of travel. Provide justifications for each trip and each person traveling. Enter each trip as a separate line item (e.g., flights to two separate conferences should be two line items: one for flights for Conference 1 and one for Conference 2). Examples for how to report each form of travel are included below. GSA per diem rates can be found here.

Airfare: round trip name of Airport to and from name of Airport, name of Airline, cost as of date, # people at $XXX per person ($XXX base fare + $XX tax and fees)

Airline checked baggage fee: # bags at $XX per bag

Airport parking: # days x # people at $XX per day

Ground transportation: # days x # people at est. $XX per day

Lodging: out-of-state rate, date, # nights x # people at $XX per day

Lodging tax: out-of-state rate, XX% per day, # nights x # people at $XX.XX per day

Mileage: round trip from place of business to destination, type of transportation, # mi. x # people at $0.XXX per mi.

Per diem (M&IE): out-of-state rate, full day, # days x # people at $XX per day

Per diem (M&IE): out-of-state rate, first & last days of travel, # days x # people at $XX.XX per day

Out-of-State Travel Subtotal

D2. In-State Travel Follow the format utilized for Out-of-State Travel (Section D1).

Airfare: round trip name of Airport to and from name of Airport, name of Airline, cost as of date, # people at $XXX per person ($XXX base fare + $XX tax and fees)

Airline checked baggage fee: # bags at $XX per bag

Airport parking: # days x # people at $XX per day

Ground transportation: # days x # people at est. $XX per day

Lodging: in-state rate, date, # days x # people at $X per day

Lodging tax: in-state rate, XX% per day, # days x # people at $XX.XX per day

Mileage: round trip from place of business to destination, type of transportation, # mi. x # people at $0.XXX per mi.

Per diem (M&IE): in-state rate, full day, # days x # people at $XX per day

Per diem (M&IE): in-state rate, first & last days of travel, # days x # people at $XX.XX per day

In-State Travel Subtotal

Combined Out-of-State and In-State Travel Subtotal

E. Materials and Supplies Materials and Supplies are items with a unit cost of less than $5,000. See Section 2.0 of the RFA for restrictions. Requests for supplies must be accompanied by a justification for the need for such items.

E1. Food Demo Supplies

[include an itemized list of the supplies requested and prices]

E2. Nutrition Education Materials

[include an itemized list of the supplies requested and prices]

E3. Nutrition Education Reinforcement Materials

[include an itemized list of the supplies requested and prices]

E4. [Insert item here]

[if applicable; include an itemized list of the supplies requested and prices]

E5. [Insert item here]

[if applicable; include an itemized list of the supplies requested and prices]

Materials and Supplies Subtotal

F. Equipment Equipment is non-expendable, tangible personal property with a unit cost of $5,000 or more with a useful life of more than one year. See Section 2.0 of the RFA for restrictions. Requests for equipment must be accompanied by a justification of the need for such items.

F1. [Insert Item Here]

[provide a justification for why this item is justified; explain rationale for estimated cost]

F2. [Insert Item Here]

[provide a justification for why this item is justified; explain rationale for estimated cost]

Equipment Subtotal

G. Other Reminder: Costs associated with sub-grantees should not be included when calculating indirect costs.

G1. Public Service radio announcement

[provide a justification for why this service is justified; explain rationale for estimated cost]

G2. Postage, Shipping/Handling

[if applicable; include an itemized list of the items requested and prices]

G3. [insert item here]

Other Subtotal

H. Totals

Total Direct Costs (Section H1): The total direct costs should be the sum of all bolded subtotals listed for Sections A-G. This number represents the total of all costs prior to calculating indirect costs.

Indirect Costs (Section H2): The Indirect Cost Rate should be applied to all appropriate funds as stipulated in your organization’s Indirect Cost Rate Agreement. Be sure to reference the terms of your organization’s Indirect Cost Rate Agreement prior to calculating indirect costs. If you require assistance, please contact your FNS Regional Office or the Grants Officer listed in Section 7.0 of the RFA.

Total Project Cost (Section H3): In Section H3, the value in your Federal Funds Requested should be the sum of the total direct costs (H1) and the total indirect costs (H2).

H1. Total Direct Costs

[Leave Blank]

H2. Indirect Costs

[Insert Indirect Cost Rate applied to your budget here as well as the effective date of your Indirect Cost Rate Agreement]

H3. Total Project Cost

9 | Page