RFR 232527 The Department of Public Health Writing and Editing RFR Application form.docx

The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619

APPLICATION FORM

RFR TITLE Department of Public Health Writing and Editing Services RFR_

First Name: [ ] Last Name: [ ]

Title: [ ]

Address:

City: [ ] State: [ ] Zip: [ ]

Telephone: ( ) - FAX: ( ) -

E-Mail: [ ]

Commonwealth Vendor Customer Code (VCC)* (if available): [ ] Address Code: [ ] *for contract execution

MAXIMUM RATE

List your maximum rate for your writing services.

Maximum Hourly Rate(s)*: [$ ] *Set for the initial duration of the contract.

1. Briefly describe your qualifications to provide writing services to DPH. (text input limit 2,500 characters, approximately 400 words):

Enter text here; text limit 2,500 characters

2. Please describe the process you used to complete a writing assignment that required you to collaborate with subject matter experts. (text input limit 2,500 characters, approximately 400 words):

Enter text here; text limit 2,500 characters

3. List writing samples you have provided. If writing samples were developed as a team, describe your contribution and indicate which sections demonstrate your writing style and skills. (text input limit 24,000 characters, approximately 4000 words):

Enter text here; text limit 24,000 characters

CATEGORY 1: Grant Writing Checklist

Applying to be considered for Category 1 – Grant Writing |_| Yes |_| No

If yes the following is a checklist of what must be uploaded to COMMBUYS as part of the Category 1 application:

|_| The Application Form |_| Resume/CV* |_| Minimum 2 successful grant applications greater than $100,000 (no more than five) |_| Completed Business Reference Form |_| All other attachments listed in COMMBUYS

* Upon request evidence of graduation from a 4 year accredited college in the form of a diploma or transcript

CATEGORY 2: Health Communication Checklist

Applying to be considered for Category 2 – Health Communication |_| Yes |_| No

If yes the following is a checklist of what must be uploaded* to COMMBUYS as part of the Category 2 application:

|_| The Application Form |_| Resume/CV* |_| Minimum of 5 writing samples from the following categories **

· Brochures

· Newsletters

· Fact Sheets

· Website content: Web address [ ]

· Social media

· Training Material

· Provider Guides

· Other Health Education Materials |_| Completed Business Reference Form |_| All other attachments listed in COMMBUYS

* Upon request evidence of graduation from a 4 year accredited college in the form of a diploma or transcript **The following submission exception applies to Category 2 only:

Every effort should be made to submit examples electronically through COMMBUYS. However if samples cannot be easily uploaded hardcopies can be mailed to the address below. A copy of the application cover form must accompany the examples. A quote must be submitted through COMMBUYS with the application form and all other required attachments or the mailed hardcopy examples will not be considered.

Elizabeth Nguyen-Vu Massachusetts Department of Public Health 250 Washington St., 8th Floor Boston, MA 02108

CATEGORY 3: Public Health Documents

Applying to be considered for Category 3 – Public Health Documents |_| Yes |_| No

If yes the following is a checklist of what must be uploaded to COMMBUYS as part of the Category 3 application:

|_| The Application Form |_| Resume/CV* |_| 2 writing samples that show programmatic experience in a particular Public Health subject area or in a Public Health related writing expertise area referenced in Section 2.0 Category 4 in the RFR.

|_| Completed Business Reference Form |_| All other attachments listed in COMMBUYS

* Upon request evidence of graduation from a 4 year accredited college in the form of a diploma or transcript

APPLICATION INSTRUCTIONS

1. Save, read and review the completed Application Response Form. Check entries in the text boxes to assure that the input limits did not shorten your response. Proof read text; spell-check does not work in the text boxes.

2. Upload in COMMBUYS the Application Response Form with the attachments according to the application Checklist.

3. Confirm that “No Charge” is checked or a dollar amount entered in the Unit Cost field on the Item screen in COMMBUYS. The “No Charge” selection will not be construed by the Purchaser to mean an offer to provide service or products at no charge.

4. Submit your electronic quote in COMMBUYS. (Vendors must be registered in COMMBUYS to submit quotes)

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