Project Award Type
**If you are applying for a Professional Development Award (up to $1,750), please use this other application form https://redcap.musc.edu/surveys/?s=78F8N9WKKCM7AD4D
* must provide value
Health Information Outreach Award (up to $20,000)
Disaster Prep and Recovery Award (up to $10,000)
Technology Improvement Award (up to $5,000)
Exhibit Award (up to $2,000)
PHS 398 FormComplete this PHS 398 form. You will be asked to attach the completed form at the bottom of this application.
Budget Justification Sample
This sample is for your reference as you complete the PHS 398 form.
Biosketch Sample
This sample is for your reference as you write a biosketch for your project's key personnel. A biosketch is shorter than a CV, and primarily asks for education/degrees, a personal statement, and any significant contributions to your field.
Statement of Work Sample
This sample is for your reference as you write a short statement of work for your project.
Project Lead:
If you are the Project Lead, write in your own name. If you are submitting this application on behalf of the Project Lead, write in their name. Note: the project lead must have their own NNLM account.
* must provide value
Project Lead email address:* must provide value
Organization Name and NNLM ID:
Please add the NNLM ID in parenthesis. For example, Medical University of South Carolina (XXXXX). Organizations must be members of NNLM to apply for funding.
* must provide value
State/Territory* must provide value
Alabama
Florida
Georgia
Mississippi
Puerto Rico
South Carolina
Tennessee
US Virgin Islands
Have you/your institution previously received NNLM funding in the current grant cycle (2021-2025)?* must provide value
Yes
No
Unsure
Project title:
Describe the project with an external audience in mind.
(If your project is funded, this title will be displayed on the NNLM website and will be provided by NLM in response to requests from NIH, HHS, OMB, Congress, and the White House.)
* must provide value
Project summary:
Provide a one-paragraph description that summarizes the proposed project.
(If your project is funded, this summary will be displayed on the NNLM website and will be provided by NLM in response to requests from NIH, HHS, OMB, Congress, and the White House.)
* must provide value
Evidence of need:
Provide a summary of how the project proposed will support the mission of NNLM, how it will meet a specific need, and describe the audience or population that will be reached through this project.
Please mention if this project will engage historically underrepresented populations and/or involve medically underserved areas. When possible, support the stated need using health statistics and needs assessment data.
* must provide value
Proposed start and end dates for the project:
Please enter the dates as follows: mm/dd/yyyy - mm/dd/yyyy.
Note: All projects must be completed by 04/30/2023.
* must provide value
Partner organizations:
If applicable, please list up to three (3) organizations that will partner with the Lead Organization to conduct the project.
Will training be provided as part of this award?* must provide value
Yes
No
Funding amount requested (numbers only):This field will only accept numbers. Enter the amount to the nearest whole dollar.
* must provide value
Other funding sources, if applicable:If you have or will be receiving funding from other sources, please list the source(s) and the dollar amount(s) here.
Project goals and objectives:
Identify 1-3 goals you hope to accomplish with this project.
A common approach to writing goals is to make them SMART: Specific – the objective is defined as clearly as possible. Measurable – you can collect data for the objective. Achievable – the objective is ambitious but also realistic. Relevant – related to your mission and to NNLM goals. Time-bound– you have a schedule for meeting the goal.
* must provide value
Implementation Plan:
Describe what actions will be taken to meet the 1-3 project goals listed above. Include a general timeline for these steps.
* must provide value
Marketing and Promotion Plan:
Briefly describe how you intend to promote your project to the focus population.
* must provide value
Evaluation Plan:
Describe how you will measure the success of the 1-3 goals you listed earlier. Identify specific outputs and outcomes, and the tools you will use to measure them, such as a survey.
Examples of outputs are: # of programs, # of participants, # of brochures distributed, etc. Examples of outcomes are: increased knowledge on a topic, decreased ER visits, increased access to internet, etc.
If you would like help developing performance measures for your project, contact us .
* must provide value
Continuation Plan:
Describe how activities and communication with the focus population will continue after the funding has ended.
* must provide value
Age Group* must provide value
Children (0-12 yrs)
Teens (13-18 yrs)
Adults (19-64 yrs)
Seniors (65+ yrs)
Sexual and gender minorities, if applicable.
LGBTQIA+
Women
Geographic Type, if applicable.
Medically Underserved Areas
Rural
Suburban
Urban
Issues & Interests, if applicable.
Social Determinants of Health
HIV/AIDS
Maternal Health
NIH Helping to End Addiction Long-Term (HEAL) Initiative
Opioids
Socioeconomically Disadvantaged Populations
Vaping
Race and Ethnicity, if applicable.
Alaska Natives
American Indians
Asians/Asian Americans
Blacks/African Americans
Hispanics/Latin Americans
Native Hawaiians
Other Pacific Islanders
Professional roles of audience* must provide value
General Public
Data Scientists
Educators (College & Post-grad)
Educators (K-12)
Emergency Preparedness and First Responders
Government Staff (Federal)
Government Staff (Local & Municipal)
Government Staff (State)
Government Staff (Tribal)
Health Professionals
Historians
Library or Information Professionals
Library Staff (Community College)
Library Staff (Health Sciences)
Library Staff (Public)
Library Staff (Other)
Community-Based Organization staff
Faith-Based Organization staff
Public Health Professionals
Researchers
Students (College & Post-grad)
Students (K-12)
Other
Completed PHS 398 form
If you need assistance filling out this form, please contact us .
* must provide value
Completed Statement of Work
Please reference sample at beginning of application.
* must provide value
Completed biosketches for key personnel
Please reference sample at beginning of application. If possible, combine all biosketches into one single document for uploading.
* must provide value
Additional attachments (optional)
If you need more space for budget justification, letters of support, etc, please attach here.
You are required to acknowledge the following statements before submitting an application:
* must provide value
You will share the information gained with colleagues in your institution/RML, as required by the Request for Proposal.
You will submit regular, interim, and final reports, as requested by the funding agency and as stipulated in the Request for Proposal.
Any web-based resources developed for this project will ensure accessibility to the greatest possible number of people.
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