Attachment 8-General Applicant Information NOFO RFA-CDC-CE20-2003.docx
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- Opportunity number
- CDC-RFA-CE20-2003
- Issued by
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Department of Health and Human Services
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Attachment 8-General Applicant Information
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Attachment 8. General Applicant Information Applicants must provide responses to the required information below.
| Information Required |
| Response |
1. Program Director/Principal Investigator (PD/PI) Name (individual who provides daily oversight of the grant, including fiscal and personnel management, community relations, implementation, and evaluation)
2. Program Director/Principal Investigator (PD/PI) Address (No P.O. Boxes)
3. Program Director/Principal Investigator (PD/PI) Phone Number
4. Program Director/Principal Investigator (PD/PI) E-Mail Address
5. Project Coordinator Name (individual who coordinates the work of the coalition and DFC activities, including training, coalition communication, data collection, and information dissemination)
6. Project Coordinator Physical Mailing Address (No P.O. Boxes)
7. Project Coordinator Phone Number
8. Project Coordinator E-mail Address
9. Evaluator Name NOTE: An Evaluator is not required under the DFC grant program. If not applicable, please state “N/A.”
10. Evaluator Physical Mailing Address (No P.O. Boxes)
11. Evaluator Phone Number
12. Evaluator E-mail Address
13. Identify Federal Congressional District of the DFC-funded Coalition. Go to http://www.house.gov for more information.
14. List Federal Congressional Districts served by coalition. Go to http://www.house.gov for more information (Item 16 on SF-424).
15. Geographical boundaries served by the coalition (e.g., city, county, streets, township, pueblo, reservations, villages, etc.)
16. List all zip codes served by the coalition. Go to: https://tools.usps.com/go/ZipLookupAction!input.action
17. Approximate total population served by the coalition.
18. Coalition must identify service area as “rural”, “urban”, and/or “suburban”. Applicants must choose only one response.
19. Is the area the coalition serves “Economically disadvantaged”? Indicate Yes or No.
20. Does the coalition serve a federally recognized tribal area? Indicate Yes or No. If yes, applicant must provide the name of tribe.
21. Does the coalition serve tribal members? Indicate Yes or No.
22. Does the coalition serve a Historically Black College and University (HBCU)? Indicate Yes or No.
23. Does the coalition have representation that includes at least one representative of the Bureau of Indian Affairs, the Indian Health Service, or a tribal government agency with expertise in the field of substance abuse? Indicate Yes or No. If yes, applicant must identify the representative’s name and organizational entity.
24. Is the applicant a religious or faith-based organization?
Indicate Yes or No.
25. Was the coalition included in a DFC Mentoring grant?
Indicate Yes or No. If yes, provide Mentoring Grant’s Award Number (SP0-xxxxx).
26. Provide the date you registered in the SAM. NOTE: Failure to have an active registration will make your application ineligible.
27. What are the demographics of the area being served by the coalition? (Caucasian, African American, Hispanic, Native American, etc.) Please provide percentages.
28. When was the substance use prevention coalition created? Provide month, day, and year.
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