Attachment A - Funding Application Form Final.xlsx
XLSX spreadsheet 75 KB Posted
- Attached to
- DFSJW DFS-CISM-2024 RFR
- Solicitation number
- BD-23-1021-DFS-DFS01-89508
- Issued by
- Massachusetts
About this file
This document is an application for the FY24 Critical Incident Stress Management Grant Program from the Department of Fire Services (DFS) in the state of Massachusetts. The application requests funding for a Critical Incident Stress Management team, including details on the number of active team members, calls for service fulfilled in the previous fiscal year, and a budget worksheet outlining requested expenses across categories such as training and conferences, travel, operating expenses and services, equipment and supplies, and professional association memberships. The total amount requested is $0.00. The application must be submitted by the team leader/director, who certifies that the information provided is accurate and agrees to abide by the terms and conditions of the funding opportunity.
The budget worksheet provides a detailed breakdown of the requested expenses, including line items for various training and conference costs, travel expenses, operating expenses and services, equipment and supplies, and professional association memberships. The application narrative explains how the requested funding will benefit the team and support their critical incident stress management activities.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| consig~35.doc | DOC document | |
| newEFT-form~14.pdf | ||
| newmass-w9~11.pdf | ||
| CISM Funding RFR 2024 Final.pdf | ||
| Bidders Response Form CISM Final.docx | DOCX document | |
| Attachment B - Request for Reimbursement Final.xlsx | XLSX spreadsheet | |
| Non Collusion Form~48.doc | DOC document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Cover Sheet
| CRITICAL INCIDENT STRESS MANAGEMENT GRANT PROGRAM | |
| FY24 Application for Funding - Cover Sheet |
Applicant Information
Legal Name of Applicant Agency:
Mailing Address: PO Box:
Municipality: Zip Code:
Team Leader/Director
First Name: Title:
Middle Initial: Phone Number:
Last Name: Email Address:
Deputy Team Leader/Director
First Name: Title:
Middle Initial: Phone Number:
Last Name: Email Address:
Team Treasurer
First Name: Title:
Middle Initial: Phone Number:
Last Name: Email Address:
Signature
As the Team Leader/Director of the , I am authorizing the team to solicit funds from the FY24 Critical Incident Stress Management Grant Program from the Department of Fire Services (DFS). I have reviewed and approve of the contents of thisapplication, and certify that all information provided is accurate. I have also reviewed and agree to abide by all terms and conditions of this funding opportunity and the associated RFR.
Name: Signature: Date:
Application Narrative
| CRITICAL INCIDENT STRESS MANAGEMENT GRANT PROGRAM | |
| FY24 Application for Funding - Application Narrative |
Team Information
Number of Active Team Members: Number of Calls for Service Fulfilled in Previous Fiscal Year:
| Application Narrative | |
| Please use the space below to summarize the requests itemized in your budget spreadsheet, explain how they will benefit your team, and note any information supporting the decisions to prioritize the requested expenses. |
Budget Worksheet
| CRITICAL INCIDENT STRESS MANAGEMENT GRANT PROGRAM | |
| FY24 Application for Funding - Budget Worksheet |
Budget Summary
BUDGET CATEGORY AMOUNT REQUESTED
| Training and Conferences | $0.00 | |
| Travel | $0.00 | |
| Operating Expenses and Services | $0.00 | |
| Equipment and Supplies | $0.00 | |
| Professional Association Memberships | $0.00 | |
| TOTAL: | TOTAL: | $0.00 |
Budget Detail
Training and Conferences ALL fields in each row must be filled out.
Total Price will not populate without all fields completed.
| Training/Conference Name | Expense Type | Quantity | Unit Price | Total Price | A/V Rental |
| Chair/Table Rental | |||||
| Room Rental | |||||
| Speaker/Instructor Fee | |||||
| Tuition/Conference Fee |
TOTAL: $0.00
| Travel | |||||
| Travel Purpose | Travel Type | Quantity | Unit Price | Total Price | |
| Airfare | |||||
| Ferry | |||||
| Lodging | |||||
| Mileage | |||||
| Parking | |||||
| Rental Car | |||||
| Taxi/Ride-Share | |||||
| Tolls |
TOTAL: $0.00
| Operating Expenses and Services | |||
| Expense/Service Description | Quantity | Unit Price | Total Price |
TOTAL: $0.00
| Equipment and Supplies | |||
| Equipment/Supply Description | Quantity | Unit Price | Total Price |
TOTAL: $0.00
| Professional Association Memberships | |||||||
| Name of Organization | Type | Start Date | Term Length | Quantity | Unit Price | Total Price | |
| Team | |||||||
| Individual |
TOTAL: $0.00
image1.jpeg
File details come from the government source that posted it. Updated .