SOI 20831 ACT CCA Program Attachment 1.Fin.pdf
PDF 105 KB Posted
- Attached to
- Assets Coming Together for Youth, Center for Community Action on Adolescent Health (ACT CCA)
- Solicitation number
- 2137825
- Issued by
- New York
About this file
This is an application form attachment for the New York State Department of Health's Assets Coming Together for Youth: Center for Community Action on Adolescent Health (ACT CCA) Program. The ACT CCA is a five-year contract (January 1, 2028 through December 31, 2032) that will support training, technical assistance, evaluation, and data collection services to 64 youth-serving adolescent sexual health and other adolescent health programs across New York State. The selected contractor will provide subject matter expertise to the Bureau of Child and Adolescent Health, conduct translational research on adolescent health topics, and support the development of comprehensive service systems for adolescents with emphasis on positive youth development and evidence-based programming. The solicitation is issued as a Solicitation of Interest and does not guarantee an award or contract; the Department reserves the right to withdraw the solicitation or issue a competitive procurement if the number of eligible applicants exceeds available funding capacity.
Eligible applicants must be not-for-profit academic, research, educational/training organizations, teaching hospitals/medical centers, or public/social policy organizations located in New York State. Organizations must demonstrate minimum three years of experience providing training and technical assistance to community-based organizations, statewide coverage capability including in-person training and site visits in both Metropolitan New York City and upstate regions, experience publishing research findings and presenting to national audiences, in-depth knowledge of youth development principles and practices, and experience collaborating with adolescent medical experts. Applicants must provide separate one-page PDF descriptions of their qualifications, a staffing plan, and existing contractual agreements demonstrating their experience. Funding for this initiative is contingent on available state appropriations, and the specific contract amounts have not been disclosed in this application document.
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Text version
NEW YORK STATE DEPARTMENT OF HEALTH
Assets Coming Together for Youth, Center for Community Action on Adolescent Health (ACT CCA) Program
Attachment 1 – Application Form
1. APPLICANT INFORMATION
Applicant Organization/Agency Name: ___________________________________________
Main Address: ________________________________________________________________
City: ______________________ State: ________________ ZIP code: ____________________
Clinic Location(s): ______________________________________________________________
Name and Title of Contact Persons:
Program Management: _________________________________________________ Telephone: (____) ___________________ E-Mail: ___________________________
Fiscal Management: ___________________________________________________ Telephone: (____) ___________________ E-Mail: ___________________________
2. ELIGIBILITY CRITERIA
Eligible Applications must:
YES | NO Be a not-for-profit academic, research, and/or educational/training organization; teaching hospital/medical center; or public/social policy organization located in New York State.
YES | NO Demonstrate a minimum of three years of experience providing training and technical assistance (TA) providing training and technical assistance to community-based organizations as evidenced by an attached PDF description
YES | NO Demonstrate statewide coverage by providing in-person training and site visits in the Metropolitan New York City area and upstate NYS, as an organization or through subcontractual relationships as evidenced by an attached PDF staffing plan and/or existing contractual agreement.
YES | NO Have experience publishing research findings and presenting relevant subject matter to a national audience as evidenced by an attached PDF description
YES | NO Have experience with and in-depth knowledge of youth development principles and practices as evidenced by an attached PDF description
YES | NO Have experience collaborating with adolescent medical experts to provide professional educational opportunities as evidenced by an attached PDF description
Demonstration of experience must be provided on a separate, single-spaced, one-page PDF that is attached to Attachment 1.
3. APPLICANT ATTESTATION
All information contained herein is true and accurate.
Executive Director/Organization Designee: __________________________ Date: _______________
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