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Utah Cancer Action NetworkUtah State Cancer Plan Implementation Grant

2020-2021www.UCAN.cc

Purpose The Utah Cancer Action Network (UCAN) is soliciting project proposals that address the priority areas outlined in the 2016-2020 Utah Comprehensive Cancer Prevention and Control Plan (State Cancer Plan). UCAN, in coordination with the Utah Comprehensive Cancer Control Program (CCC), developed this plan as a roadmap for all organizations and individuals fighting cancer in Utah. The plan addresses the following four priority areas: physical activity and nutrition, skin cancer, cancer screening, and cancer survivorship and quality of life. Successful grant applications will incorporate goals and strategies from the UCAN priority areas outlined in the State Cancer Plan.

Please note that proposals are not being accepted for the collaboration priorities at this time.

Background

UCAN is Utah’s comprehensive cancer control coalition, comprised of a diverse, professional group of stakeholders from across the state dedicated to reducing the burden of cancer in Utah. UCAN brings together organizations and individuals throughout the state working to fight cancer, empowering them to be successful. UCAN is dedicated to developing and supporting innovative policy, system, and environmental changes at the state and community levels.

Notable Changes from Previous Applications This application has been updated for Fiscal Year 2021. Below is a summary of notable changes. Please note, this is not a comprehensive list. It is important to read this application cover to cover.

Number of expected awards has decreased from 3-6 in FY2020 to 1-3 in FY2021. The number of anticipated awards is based on program budgets and is subject to change.

Project Description section of the application has been updated. Applicants must now state whether their proposal is an expansion of an existing project and if so, describe new activities and outcomes.

Letters of Intent (LOI) are no longer required. No webinar will be held this year. For all inquiries regarding this funding opportunity, please contact Brad Belnap

at [email protected] no later than February 13, 2020. Application Restrictions section of the application has been updated to include restrictions on current grantees

applying for additional funding. Application submission will be done via the UCAN website HERE

http://www.ucan.cc/members/implementation/submission/

mailto:[email protected]

http://www.ucan.cc/state-cancer-plan/

http://www.UCAN.cc/

www.UCAN.cc/state-cancer-plan/

Grant Summary Grant Title: Utah State Cancer Plan Implementation Grant

Application Release Date: December 17, 2019

Funding Period: June 30, 2020 through June 29, 2021

Application Submission Date: February 26, 2020 by 5:00 PM MST via the UCAN website. Incomplete or late applications (submitted after 5:00 PM MST on February 26, 2020) will not be accepted or reviewed.

Application Type: Single-year or multi-year (up to 3 years)

Funding: Applicants may request up to $20,000 per year. Applicants applying for more than $10,000 per year will need to provide sufficient justification to demonstrate that this amount of funding is needed.

Anticipated Awards: One to three

Payment Method: Cost Reimbursement. All awardees will be reimbursed for allowable costs incurred as part of this initiative.

Selection Method: Competitive Bid

Cost Sharing: All awardees will be required to contribute a minimum of 10% of the funded amount as in-kind contributions to the project. In-kind contributions must be tracked and reported throughout the project period. See Appendix B for budget information.

Application Information and Requirements All proposed projects must align with at least one State Cancer Plan goal and strategy from the UCAN Priorities

Section. Refer to the State Cancer Plan located at www.ucan.cc/state-cancer-plan/. Applications not aligned with the State Cancer Plan will not be accepted.

Project activities must occur within Utah. A Letter of Support (LOS) from each project partner must be included with the application. At least one project

partner is required. Applications must be submitted by 5:00 PM MST on February 26, 2020 via the UCAN website at

www.ucan.cc/members/implementation/. Incomplete applications and/or late materials will not be reviewed or scored. Please refer to the applicant checklist for list of required materials.

Application must be in one PDF document. Applications submitted in multiple separate files will not be accepted or reviewed. Please contact Brad Belnap at [email protected] if you need assistance with your application packet.

Applicants are encouraged to join UCAN. To join UCAN, please click HERE to access the new member form. Funded proposals are required to submit an abstract for their project to the annual UCAN Conference.

Application Restrictions Grant funds may not be used for lobbying. Any applications proposing public policy or advocacy components will

be heavily scrutinized to ensure activities are allowable.

2/27Revised: December 16, 2019

http://www.ucan.cc/become-a-member/join-now/



www.UCAN.cc/state-cancer-plan/ Grant funds may not be used to pay for clinical care. Clinical care includes (but is not limited to) using grant

funds for purchasing or administering cancer screenings, medication, vaccinations, patient care, etc. Projects including a clinical care component are encouraged to leverage community partnerships to pay for these activities.

Grant funds may not be used to pay for construction. Projects including construction activities are encouraged to leverage community partnerships to pay for these activities.

Grant funds may not be used to pay for indirect costs. All costs must be related to the project proposal and be outlined and justified in the budget.

Applicants requesting funding for equipment must justify why the equipment is necessary to achieve project goals. Examples of equipment include permanent signage, sports equipment, raw materials or construction supplies, garden supplies, sunscreen, etc. All applications requesting funds for equipment will be heavily scrutinized.

Recipients of the FY2020 UCAN State Cancer Plan Implementation Grant whose project will be funded during the 2020-2021 funding period are not eligible to apply for this opportunity. Previous recipients whose funding has ended are eligible to apply for new funding.

Application Assistance Applicants have the opportunity to submit questions regarding the application. Questions should be emailed to Brad Belnap at [email protected]. Please include the following in the subject line: Utah State Cancer Plan Application Question. Questions received without this subject line may go unanswered . Submitting questions is optional. The deadline to submit questions is February 13, 2020. No questions will be answered after this date.

All submitted questions and answers will be made publically available. This information will be posted to the UCAN website at the following address: http://www.ucan.cc/members/implementation/

Application Timeline December 17, 2019 – Request for Proposals (RFP) released

February 13, 2020 – Last day to submit application questions

February 26, 2020 – Applications are due electronically by 5:00 PM MST via the UCAN website.

March 11, 2020 – Award notifications and application feedback sent to applicants

June 12, 2020 – Contract between grantee and UDOH signed

June 30, 2020 – Project period begins

Review Process All applications submitted under the guidelines above will be reviewed for completeness and receive feedback. A committee comprised of at least four UCAN members and/or external partners will evaluate completed applications using a standardized score sheet. See Appendix A for a sample score sheet.


http://www.ucan.cc/members/implementation/



Single and Multi-Year Application Opportunities Applicants have the option of applying for either a single-year project or a multi-year project (up to three years). Each opportunity has specific expectations and requirements, outlined below.

Single-year application Multi-year application

Outcomes must realistically be achieved in a single year.

Infrastructure necessary for project completion must be in place before project commences.

Partnerships with necessary stakeholders and the target population should already be in place.

Must demonstrate project sustainability. One-time interventions will not be prioritized for funding.

Outcomes must realistically be achieved in no more than three years.

It is expected that applicants may need to build relationships with the target population and/or key stakeholders.

It is expected that infrastructure necessary for project completion will be developed or established.

Applicants must demonstrate significant progress towards project goals in year one, showing a high likelihood of reaching year two and three objectives.

Funding for years two and three are subject to competitive renewal and not guaranteed.

Application Checklist The following items are required to be included with each application. Applications with missing or incomplete items will not be reviewed or scored.

☐Organization Background☐Project Description☐Alignment with the State Cancer Plan☐Project Evidence for Success☐Description of Target Population and Health Disparities☐Action Plan☐Description of Project Partners☐Evaluation Plan☐Plan for Sustainability☐Budget☐Letters of Support for each Project Partner included☐Application submitted as one pdf document via the UCAN website



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Utah State Cancer Plan Implementation Grant Application

Organization BackgroundPlease provide information regarding the organization applying for funding. This information will help reviewers better understand who is applying for project funding.

Organization BackgroundOrganization Name:

Brief organization description (mission, population served, relevance to proposed project, etc.):

Organization’s relevant experience completing similar activities:

Project DescriptionPlease provide a summary of your proposed project. This information should be short and concise to help reviewers gain a high-level understanding of your proposal. If you are proposing funding for an existing project or program, you must state how this funding will be used to significantly expand the project, including a description of new activities and expected outcomes as a result of this funding.

Project DescriptionProject Title:

Project Lead Name:

Address:

Phone #:Email:

Funding Amount Requested: $Brief description of proposed project including goals, general activities, anticipated outcomes, summary of timeline, relevant collaborators, etc.:

Is this an expansion of an existing project or program?☐ YES☐ NO


www.UCAN.cc/state-cancer-plan/If this proposal will expand on an existing project or program, please describe the new activities and outcomes expected as a result of this funding.:

Alignment with the State Cancer PlanThe State Cancer Plan outlines the following four UCAN priority areas: physical activity and nutrition, skin cancer, cancer screening, and cancer survivorship and quality of life. All proposals must select an intervention that addresses one of these priority areas and at least one strategy from the State Cancer Plan. Please note that proposals are not being accepted for the collaboration priorities at this time.

The action steps listed under each strategy in the State Cancer Plan are examples of recommended interventions that are likely to yield intended outcomes when implemented correctly.

Alignment with the State Cancer PlanPlease select from the list which UCAN Priority Area(s) this project will directly address:

☐ Cancer Screening ☐ Physical Activity or Nutrition☐ Skin Cancer☐ Cancer Survivorship and Quality of Life

Please identify the primary State Cancer Plan goal this project aligns with:

Please identify the strategy this project aligns with:

(Optional) Please identify a secondary relevant State Cancer Plan goals this project aligns with:

(Optional) Please identify a secondary relevant State Cancer Plan strategy this project aligns with:

Project Evidence for SuccessIt is required that applicants propose interventions that address the selected strategy(s) from the State Cancer Plan. It is expected that proposed interventions will have a high likelihood of achieving expected outcomes. Applicants should provide a rationale for why the intervention was chosen. The best way to do this is by providing scientific evidence that supports that the intervention will be effective when properly implemented.

This evidence can come from a variety of sources. Examples include: The Community Guide: https://www.thecommunityguide.org Research-tested Intervention Programs (RTIPs): http://rtips.cancer.gov/rtips Cancer Control P.L.A.N.E.T.: http://cancercontrolplanet.cancer.gov Scholarly journals and peer-reviewed articles


http://cancercontrolplanet.cancer.gov/

http://rtips.cancer.gov/rtips

https://www.thecommunityguide.org/



Project Evidence for SuccessPlease explain your chosen intervention(s):

What evidence has been found to support this intervention(s)? Please include a link or describe where this evidence can be found:

Why did you choose this intervention(s) over other intervention(s)?

Target Population and Health DisparitiesPlease describe the population you aim to impact in some way. It is expected that applicants will understand both who they are targeting and why they are working with this population. This includes the importance of understanding and addressing challenges the target population may face compared to other populations in achieving health outcomes. Many communities in Utah face significant disadvantages to being healthy that are innately avoidable, unnecessary, and unjust. These differences are referred to as health disparities.

Healthy People 2020 defines health disparity as, “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” (HP2020)

Projects aiming to address a health disparity(s) will be prioritized for funding. For further definitions of health inequity, disparities, and access please see page 17 of the State Cancer Plan.

Target Population and Health DisparitiesPlease describe the specific Target Population(s) to be reached (i.e. geography, race, socioeconomic status, gender, etc.):

What is the need within this population that this intervention will address?

Please describe the health disparity this target population experiences related to this project:

How will your proposed project work to achieve health equity and address the disparities described above?


http://www.ucan.cc/wp-content/uploads/2015/12/State-Cancer-Plan-Revision-2.pdf

https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

www.UCAN.cc/state-cancer-plan/Please describe the data source(s) used to identify the health disparities experienced by the target population (population-level data, environmental scans, surveys, needs assessments, etc.):

How do you plan to engage the target population?

What culturally appropriate strategies will you employ to better reach this population? Please include a brief rationale for the strategies you selected:

Estimate the number of Utahns who will be impacted by this project:

Action PlanThis action plan outlines objectives and activities that will occur during the project period. Objectives provide a clear and measurable target you expect to attain. Activities are specific actions or tasks necessary to achieve the objective. Applicants must describe who is responsible for completing each objective. It is assumed that funding will be spent on any and all activities outlined in the action plan unless otherwise stated. Please ensure activities are allowable and the budget clearly aligns with the action plan.

It is required that objectives be SMART (Specific, Measurable, Achievable, Realistic, and Time-bound).

Specific: What specific measure is being targeted with this objective?Measurable: How will you measure change in the chosen objective?Achievable: Can the measure be reached in the given timeframe and with given limitations?Realistic: Can you reasonably expect that the objective will be accomplished?Time-Bound: What is the specific timeframe or deadline that the objective will be completed by?

A minimum of two objectives are required. If necessary, add more rows for additional objectives or activities.

Example Action Plan is found in Appendix C

Year 1 Action Plan

Objective 1Please state a specific, measurable, achievable, realistic, and time-bound project objective:


www.UCAN.cc/state-cancer-plan/Please break your objective into its SMART components:

Specific: Measurable: Achievable: Realistic: Time-Bound:

Activity 1: (What activities will lead to achievement of this objective? At least one is required.)

Activity 2:

Activity 3:

Individual/organization responsible for this objective:


Please break your objective into its SMART components: Specific: Measurable: Achievable: Realistic: Time-Bound:


Activity 2:

Activity 3:


Objective 3 (optional)Please state a specific, measurable, achievable, realistic, and time-bound project objective:




www.UCAN.cc/state-cancer-plan/Activity 2:

Activity 3:


Year 2 Action Plan (multi-year applications only)




Activity 2:

Activity 3:





Activity 2:

Activity 3:



www.UCAN.cc/state-cancer-plan/Objective 3 (optional)Please state a specific, measurable, achievable, realistic, and time-bound project objective:



Activity 2:

Activity 3:


Year 3 Action Plan (multi-year applications only)




Activity 2:

Activity 3:




www.UCAN.cc/state-cancer-plan/Please break your objective into its SMART components:

Specific: Measurable: Achievable: Realistic: Time-Bound:


Activity 2:

Activity 3:


Objective 3 (optional)Please state a specific, measurable, achievable, realistic, and time-bound project objective:



Activity 2:

Activity 3:


Description of Project PartnersProject partners are organizations or individuals who will actively collaborate on this project. At least one is required. A Letter of Support is required for each project partner.

If necessary, add more rows for additional partners.

Description of Project PartnersProject Partner 1


www.UCAN.cc/state-cancer-plan/Partner name:

Organization Partner Represents:

Brief Organization Description:

Email:

Partner Role and Responsibilities in this Project (Please be specific):

Project Partner 2 (optional)Partner Name:

Organization Partner Represents:

Brief Organization Description:

Email:

Partner Role and Responsibilities in this Project (Please be specific):

Evaluation PlanApplicants are required to develop a plan for how the chosen intervention(s) will be evaluated. The CDC defines evaluation as, “the systematic collection of information about the activities, characteristics, and outcomes of programs to make judgments about the program, improve program effectiveness, and/or inform decisions about future program development.” An evaluation plan is an integral part of the evaluation process that does the following:

-Helps you decide what sort of information you and your stakeholders really need-Keeps you from wasting time gathering information that isn't needed-Helps you identify the best possible methods and strategies for getting the needed information-Helps you come up with a reasonable and realistic timeline for evaluation

Detailed instructions and an example Evaluation Plan are found in Appendix D

Evaluation Plan1. Evaluation question 1 (at least one is required):



Evaluation question 2:

Evaluation question 3:

2. What baseline data will you use?

How will you collect this baseline data?

When will you collect comparison data?

3. What other measure(s) will you use to determine your intervention has been successful?

How will you collect this data?

4. Award recipients will be required to present on their interventions at the Annual UCAN Conference. How will you prepare your evaluation data to share with others working in cancer prevention and control?

How else do you anticipate sharing your evaluation results with intervention stakeholders?

5. Who will oversee the evaluation component of the project?

Name

Email/Phone

☐ (Check if your organization does not have in-house evaluation capacity)

6. What challenges do you foresee in evaluating this project?

Plan for SustainabilityApplicants are required to demonstrate how the impact of the proposed project will be sustained after this grant funding has ended. Projects that are not intended to, or cannot be, sustained beyond one year will not be prioritized for funding.

Please note, physical durability of infrastructure, equipment, or the built environment is not considered the same as program sustainability. For example, a well-built playground may physically last 50 years, however this does not


www.UCAN.cc/state-cancer-plan/guarantee the equipment will be used or that program outcomes will continue to be achieved. Applicants are expected to outline how the program will continue and impact will be achieved after initial funding has ended.

Plan for SustainabilityWhat long-term outcomes do you anticipate arising from this initial funding?

What steps will be taken to ensure the above items will be sustained?

In what ways will your project continue after funding has ended?

Budget Applicants must provide a budget outlining all expenses related to the proposal. Budget categories have been provided in the template below. All activities requiring funding must be outlined in the budget template. For detailed instructions see Appendix B.

Example Budget and instructions provided in Appendix B

Year 1 BudgetCategory Justification UCAN Funds In-Kind

Funds Staff Support

Travel

Materials and Supplies

Other



Totals $ $

Year 2 Budget (multi-year applications only)Category Justification UCAN Funds In-Kind

Funds Staff Support

Travel


Other

Totals $ $

Year 3 Budget (multi-year applications only)Category Justification UCAN Funds In-Kind

Funds Staff Support

Travel




Other

Totals $ $



Appendix A: Sample Score Sheet Please note: this sample score sheet is provided for reference only and is subject to change. To help applicants better understand the process and improve their future applications, all applicants will receive their scores and reviewer comments after the application review process has concluded.

OVERALL PROJECT (20 POINTS)Project poorly constructed, inappropriate for this application, or would show little potential for impact and reach. Project would struggle to address priorities in the State Cancer Plan, has little or no evidence showing potential success, and/or would not be successful.

Project somewhat described but without enough detail to gauge impact, or project as described would not be effective or impactful. Little evidence to support intervention. Potential impact is weak. Doesn’t engage target population in meaningful way or would not adequately address the need.

Project well described, demonstrates sufficient evidence of potential success, and clearly would impact target population. Project would be effective as described at achieving stated outcomes, but could be improved in some minor ways.

Innovative project that is well crafted and with high potential for success; clearly address a need, would work towards health equity, and engages the target audience in a successful way. Has high potential for large and lasting impact. Few if any changes or improvements could be made to enhance project.

(0-5) (5-10) (11-15) (16-20)Comments: Score:

PROJECT ACTION PLAN (10 POINTS)Action plan is incomplete or clearly fails to describe key elements of proposed intervention. Objectives are not SMART

Action plan contains minimum elements, but stated objectives or activities would not be sufficient for program implementation. Objectives may be left out or insufficiently described. Person responsible for activity may not make sense or be appropriate.

Action plan is complete and describes all core components of the project. Objectives are complete, but activities may not be sufficiently described. Some details may be left out or not sufficiently described.

A sufficient amount of detail and thought went into the action plan. The number of objectives and activities is appropriate, and no major details have been excluded. Person responsible makes sense and will enhance likelihood of success.

(0-2) (3-5) (6-8) (9-10)Comments: Score:

CLARITY OF PROJECT OBJECTIVES AND ACTIVITIES (10 POINTS)Project objectives are unclear or inappropriate; objectives not offered or not SMART; activities are not detailed, missing, and/or do not show how objectives can be completed.

Project objectives are clear, but may or may not be SMART; questionable objectives are offered that are weak or lack specificity or measures; activities lack detail and/or don’t clearly link to objectives.

Project objectives are well framed and adequate; objectives are SMART and sufficient to the task but could perhaps be strengthened; activities link to accomplishment of objectives but may lack some detail.

Project objectives are very well crafted and comprehensive; each SMART element is well thought through. Activities are detailed and clearly linked to objectives, and necessary for success.

(0-2) (3-5) (6-8) (9-10)Comments: Score:

PROJECT PARTNERS (10 POINTS)Appropriate partners or stakeholders are not involved, or no partners are identified in action plan. Letter(s) of support are missing and/or do not

Some appropriate partners or stakeholders appear to be missing from action plan or are poorly described. Letter(s) of support do not demonstrate a

The partners and stakeholders identified will benefit the project overall and their roles are clearly stated in the action plan. Letter(s) of support adequately

The partners and stakeholders identified in the action plan are comprehensive and well developed. No valuable partnerships have been excluded.


www.UCAN.cc/state-cancer-plan/demonstrate a clear understanding of partner’s role.

clear understanding of partner’s role and/or role differs between action plan and LOS.

demonstrate a clear understanding of partner’s role, which matches the action plan.

Partner role will greatly enhance the project. Letter of support and action plan clearly indicates the partners’ role in project.

(0-2) (3-5) (6-8) (9-10)Comments: Score:

PROJECT EVALUATION (15 POINTS)Evaluation measures and methods are lacking, not clear, or not linked to objectives in action plan; evaluation questions not related to action plan or project outcomes; does not clearly understand what success and/or progress looks like. Insufficient data is collected or used. No clear plans for dissemination.

Evaluation measures could be enhanced or improved; evaluation questions are not well defined, but do relate to action plan and objectives. Measures are not well thought out or could be improved. Data collection and usage could be improved. Plans for dissemination are weak.

Evaluation questions and methods are adequate as offered, linked to objectives in action plan. Evaluation questions are thoughtful and provide a clear direction for evaluation activities. Measures and baseline data are clearly constructed, but may need improvement. Plans for dissemination are adequate but could be improved.

Evaluation questions and methods are very well designed, closely tied to action plan, and clearly will provide valuable insight to the project. Measures and baseline data are clear, accurate, and represent the best approach to understanding the program. The evaluation plan clearly outlines how data will be used and dissemination is prioritized.

(0-3) (4-7) (8-11) (12-15)Comments: Score:

PROJECT BUDGET and BUDGET JUSTIFICATION (10 POINTS)Budget is very poorly constructed and disconnected from project or does not fund activities related to project. Budget justification is missing or excludes key items. Budget contains unallowable items. In-kind contributions do not relate to project or do not make up at least 10% of budget.

Budget appropriately connected to the project with some exceptions. Not all budget items are included in justification or some items are not included in the action plan. Budget may contain restricted items. In-kind contributions do not all relate to project and/or do not make up at least 10% of budget.

Budget matches well with scope or work as offered and is appropriate to the work, however some items may not be sufficient or appropriate for proposal. All items have adequate justification. Budget contains no restricted items. In-kind contributions relate to project and make up at least 10% of budget.

Budget is well crafted, efficient, and in synergy with project plan. Budget justification includes all items listed in budget and adequately reflects proposed work and project needs. Budget contains no restricted items. All in-kind contributions enhance the project and make up at least 10% of budget.

(0-2) (3-5) (6-8) (9-10)Comments: Score:

PROJECT SUSTAINABILITY (Continuation of Funds and Lasting Change) (10 POINTS)Project does not or cannot demonstrate sustainability after grant funding has ended. Description of sustainability may be offered but is unrelated to project or misunderstands what it means to sustain a program.

Project has the potential for sustainability after grant funding, but more details are required. Project does not sufficiently demonstrate feasible, lasting change. May provide justification for sustainability, but clear elements are missing.

Project has a defined, manageable plan for sustaining project after funding. Project demonstrates feasible, lasting change in target population, and approaches policy, system, or environmental changes, but could be improved. Some components of program may not be sufficiently sustained. Partnerships are referenced, but not well thought out.

Project clearly demonstrates how it will lead to lasting changes, including policy, system, or environmental changes. Action plan clearly aligns with sustainability and will have high likelihood of long-term impact. Role of partners clearly understood and utilized.

(0-2) (3-5) (6-8) (9-10)Comments: Score:



PROJECT IMPACT (Population Size and Reach) (15 POINTS)No specific Utah population identified or project not linked to impact in the target population. No inequity or disparity is identified or is not related to project. Project does not justify funding to impact target population, or population is unnecessarily small.

Project identifies specific Utah population, but plans will make little impact in targeted community. Target population not engaged sufficiently. Health disparity is identified, but poorly understood and not likely to be impacted in a meaningful way.

Project impacts specified Utah population, and will make an impact in targeted community. Target audience is engaged in intervention in a meaningful way. Health disparities are addressed, though could be improved.

Project impacts specified Utah population, and will make a significant impact in the targeted community. Project engages target population in innovative and effective ways. Health disparities are prioritized, clearly understood, and addressed in an impactful way.

(0-3) (4-7) (8-11) (12-15)Comments: Score:

OVERALL COMMENTS/RECOMMENDATIONSOverall comments/recommendations: Total score:

_______ / 100



Appendix B: Sample Budget Please note: this example is provided to help guide applicant’s understanding of each of the required budget elements and is not representative of a complete or robust budget.

Category: The budget template is broken into four budget categories: staff support, travel, materials and supplies, and other.

- Staff Support: This category is for outlining funding for staff to fulfill a specific role in implementing the proposed intervention. All staff listed in the budget must have an active role in the program.

- Travel: If your proposal requires staff travel, these trips must be outlined here. Travel not associated with program implementation is not allowable, including paying for patients or clients to travel to and from services. All travel will be reimbursed at the state rate of $0.42 per mile.

- Materials and Supplies: Any proposal requesting materials, supplies, printing, mailing, or other costs associated with implementing a program should outline these costs here. Only materials and supplies that are necessary for the implementation of the proposed intervention will be reimbursed. These costs cannot include general operating expenses or other costs that are not directly related to the proposed intervention.

- Other: Any allowable expense not covered by a category can be listed here. All other costs will be heavily scrutinized to ensure they are allowable under this funding opportunity and related to action plan objectives.

Justification: Each budget item must be justified. Any budget item lacking justification will not be considered. Justification must include how this item relates to the project proposal must align with specific objectives and activities in the action plan. Any budget items that do not relate to the project or are not aligned with the action plan will not be allowed.

UCAN Funds: UCAN Funds are any funds that the applicant is requesting from UCAN. The total UCAN Funds requested in the budget must not exceed $20,000 for each budget year. In accordance with the requirements of this RFP, these funds are dispersed on a cost-reimbursement basis. This means that the grantee will need to incur a cost first before being reimbursed.

In-Kind Funds: In-kind funding is the monetary value of any contributions to the initiative made in addition to the UCAN funds received. In-kind funds can come from contributions of goods, services, or staff and volunteer time. Applicants are required to contribute effort to implementing the proposal in addition to the UCAN funding received.

Sample BudgetCategory Justification UCAN Funds In-Kind

Funds Staff SupportProgram Director- 570 hours at $20/hr. (11 hr/wk x 52 weeks x $20/hr)

The Program Director will oversee implementation of the intervention, will facilitate quarterly partner meetings, and report all progress as required.

$10,400 --

Health Education Specialist- 78 hours at $15/hr. (3 hr/wk x 26 weeks x $15/hr)

The Health Education Specialist (HES) is responsible for conducting in-person trainings and designing small media materials outlined in objective 1, activities Y and X. The HES is available through a partnership with X

-- $1,170


www.UCAN.cc/state-cancer-plan/program partner. These activities are provided in-kind.

TravelFour roundtrip visits to Utah County to meet with program partners. (40 miles per trip x $0.42 x 4)

Partners in Utah County will need guidance on implementing program objective 1, activities X and Y. Our program will provide in-person technical assistance once every quarter during the project period.

$67 --

Materials and Supplies600 color brochures at .50 cents each

Brochures will be provided to clinics to educate their patients about X and Y. These items align with objective 2.

$300 --

OtherLunch for 20 people Lunch will be provided to participants of our

quarterly meetings outlined in objective 3 to help ensure attendance and support partners. Funding is provided in-kind.

-- $160

Totals $10,761 $1,330



Appendix C: Sample Action Plan Please note: this example is provided to help guide applicant’s understanding of each of the required action plan fields and is not representative of a complete or robust action plan.

Sample Action PlanObjective 1Please state a specific, measurable, achievable, realistic, and time-bound project objective:Increase the number of grant applications offered to UCAN members from 1 to 2 by December 17, 2019.

Please break your objective into its SMART components: Specific: UCAN Projects and Funding Subcommittee members will develop one grant application to be

offered to UCAN members. Measurable: The number of grant applications developed for 2020 will be increased from one (FY20) to

two, an increase of 100%. Achievable: Previous applications exist which can provide a framework for developing the current

application. UCAN Administrative Team members have extensive experience developing grant applications on a short timeline.

Realistic: In FY17, FY16, and FY15, UCAN Administrative Team members developed and fielded one grant application before the end of October. The Comprehensive Cancer Control Program Manager has extensive skills developing these applications, and 10 UCAN members have agreed to contribute expertise to developing the application.

Time-Bound: The application will be completed and fielded on or before December 17, 2019.Activity 1: (What activities will lead to achievement of this objective? At least one is required.)Review previous applications to determine strengths and weaknesses.

Activity 2: Work with UCAN leadership to determine criteria for proposals and funding requirements.

Activity 3: Draft application and solicit feedback from Project and Funding Subcommittee members.

Individual/organization responsible for this objective: Brad Belnap, Utah Department of Health Comprehensive Cancer Control Program Manager



Appendix D: Sample Evaluation Plan The following information is provided as guidance to help applicants develop their evaluation plans.

1. At least 1 evaluation question is required. Evaluation questions articulate the main issues that will be explored by the evaluation. They are usually developed after the goals and objectives of a program have been decided and the activities to support those objectives have been determined. These questions are the high-level questions that an evaluation is designed to answer - not specific questions that are asked in an interview or a questionnaire. Evaluation questions are useful to:

-Focus and provide structure to an evaluation-Guide the evaluation planning process, including data gathering and the methods to be used to obtain the information that is important to the program implementers, the beneficiaries, donors and other stakeholders -Inform how the results will be incorporated back into planning and implementation to improve the program

Examples:-Did participant knowledge change after attending the program?-Is the program being implemented correctly?-What has been the ration of program costs to program benefits?

2. Applicants should identify the baseline data that will be used to measure if the intervention has been successful. Baseline assessments should be conducted before the implementation begins to serve as a benchmark for change. Comparison data should be collected at intervals during the intervention and/or at the end of the intervention to monitor what changes occur because of the intervention. This data should directly measure at least one of the objectives you identified in the previous section.

Examples: -Colorectal cancer screening rates will be collected using the EHR before the outreach intervention begins and then collected every six months for the two-year project period. -How much patients learned about healthy eating will be measured by giving patients a pre and post survey before and after the six-week program session-The number of wellness policies in place will be measured by conducting a key informant interview with the business owner before and after the policy incentive is implemented

3. Applicants should identify additional measures to determine the outcomes of the intervention. The method of collecting this information should also be identified. This data should directly measure the remaining objectives identified in the previous section.

Examples:-Number of outreach events conducted by recording each outreach event in an Excel sheet-Number of participants that attend a community event by having each participants sign in at the event-Participants’ satisfaction with the program by administering a survey to program participants after the program is over

4. Award recipients will be required to present on their intervention(s) at the Annual UCAN Conference. This will


www.UCAN.cc/state-cancer-plan/ensure that others working in cancer prevention and control in the region know about the great work that is being done and will allow for sharing knowledge and experience.

5. Applicants are required to identify an evaluation point person. The role of this person may vary by organization. They may be in charge of managing the evaluation plan, conducting all evaluation activities, or if there is no in-house evaluation capacity, act as a liaison with the UCAN evaluation subcommittee.

6. Evaluation planning, implementation and dissemination can often change or hit snags as interventions progress. Applicants should identify any potential challenges they may encounter with evaluating this project.

CDC’s evaluation tools and resources can be found at: https://www.cdc.gov/eval/index.htm

Sample Evaluation Plan1. Evaluation question 1 (at least one is required): Was this program effective at increasing colorectal cancer screening rates?

Evaluation question 2: Was the program implemented appropriately?

2. What baseline data will you use? Clinic-level colorectal cancer screening rates among age-eligible patients

How will you collect your baseline data?Baseline rates will be collected using the EHR before the outreach intervention begins.

When will you collect comparison data?Screening rates will be collected every six months for the two-year project period.

3. What other measure(s) will you use determine your intervention has been successful?Ease of implementation on clinic staff Increase in screening among the Pacific Islander population. How will you collect this data? A survey will be developed for clinic staff and QI management after the intervention was completed to gather qualitative feedback regarding implementing this program. The survey will include questions regarding amount of time spent completing activities, challenges encountered, and ideas for improvement. In addition, a pre/post assessment will be completed of Pacific Islander patients who have not been screened in the last 5 years to see if the intervention increased rates in this population.4. Award recipients will be required to present on their interventions at the Annual UCAN Conference. How will you prepare your evaluation data to share with others working in cancer prevention and control?Both quantitative and qualitative data will be used to develop a model for practice in other clinics with similar populations that includes step-by-step processes for clinic staff to implement the intervention. This model can be prepared in an easy-to-understand format and can be presented to the cancer community at this conference and at other events around the state.

How else do you anticipate sharing your evaluation results with intervention stakeholders?Program outcomes data will be shared with clinic management and staff to help them understand how this


www.UCAN.cc/state-cancer-plan/intervention impacted their work.

5. Who will oversee the evaluation component of the project?

Name Brad Belnap

Email/Phone [email protected]

☒ (Check if your organization does not have in-house evaluation capacity)

6. What challenges do you foresee in evaluating this project?EHR data will need to be collected using standard criteria which may not be available at every clinic or with every EHR system. Criteria may need to be tailored to each participating clinic. Chart pulls may also need to be used if EHR data is not available, which can be time and labor intensive and require additional guidance with clinic staff.


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