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Version Date: August 2016
Seed Grant Program
Application Package (A)
For
Cycle 2: September, 2016 Competition
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 2 of 12
Seed Grant Program
Cycle 2: September, 2016 Competition
The BC Centre for Palliative Care in partnership with the BC Hospice Palliative Care Association invite all Hospice Societies through British Columbia to apply to the Seed Grant Program. The Seed Grant Program provides funding, guidance and support resources for novel, scalable projects that help promote any of the following strategic priorities for palliative and end of life care in BC:
1. Advance Care Planning: Promote and facilitate public and private conversations about Advance Care Planning;
2. Palliative Care Education: Raise awareness of and provide education to the public, formal care providers, and informal caregivers about the palliative approach to care;
3. Compassionate Communities: Engage and empower local communities to look after terminally ill
patients, providing palliative care closer to home and improving the end of life experiences in the community
Complete applications must be received by email to: [email protected] no later than September 26th, 2016. All applicants will be notified of the results by email by October 21th, 2016.
For more information about Cycle 2, please see the Seed Grant Guidelines and informational presentation at http://www.bc-cpc.ca/cpc/seed-grants/
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 3 of 12
Seed Grant Application (A)
Project Overview
Title of Project:
Project lifetime:_________ (12 months maximum)
Budget Requested: $ _______________ ($5000 maximum):
Applicant Information:
Name of Hospice Society:
Address:
Contact Person Name:
Title:
Email: Phone: Fax:
Identify ONE (1) Person who will be responsible for leading the project.
Project Lead Name:
Title:
Email:
Phone: Fax:
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 4 of 12
Project Information:
Funding Priorities – Check ONE funding priority that this project most closely aligns with
☐ Advance Care Planning
☐ Palliative Care Education
☐ Compassionate Communities
The project will be take place in the:
☐Interior Health Region
☐Northern Health Region
☐Fraser Health Region
☐Vancouver Island Health Region
☐Vancouver Coastal/Providence Health Region
The community in which the project will take place is:
☐A community in an urban or suburban area
☐A community in a rural area (>10,000 and <40,000 residents
☐A First Nation community
☐A community in other remote area (<10,000 residents)
Highlight the primary focus of impact for your project
☐The general public
☐Patients with serious illness
☐Frail seniors
☐Young adults with life limiting illness
☐Families and informal caregivers of patients with serious illness
(you can check more than one category):
☐Minority ethnic population
☐Health care professionals and formal caregivers (paid)
☐Individuals with mental illness
☐Homeless people
☐Other group,________________________(specify)
Brief Description of the Project (no more than 300 words):
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 5 of 12
Signature:
Name of the Organization that will receive and administer the fund: _________________________________________________________________________________ Name of Authorized Person: ___________________________________________ Authoritative Signature: ________________________________________________
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 6 of 12
Project Details
The Problem
Provide a clear understanding of the problem and identify the population group(s) who are affected by this problem
(Not More than 200 words)
The Opportunity
Provide a clear understanding of the opportunity at hand (include, where relevant, if this project could be scalable
across multiple settings, age groups, cultural backgrounds, etc) (Not More than 200 words)
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 7 of 12
Project Goal and Objectives– describe what the project will try to achieve
Partners
List of Partners who expressed interest or expected to work with and participate in the project’s activities
Partner’s Name Expected Role in Project
Team Members
List of team members who will be involved in the project
Name Area of Expertise Role in the Project Email address
Convening, Collaborating, Catalyzing to Create Capacity
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Activities and Timeline List the activities that will be undertaken to achieve the project objectives. Highlight the month during which an activity will take place (see sample below).
Key Activities Examples
Months 1 2 3 4 5 6 7 8 9 10 11 12
1 Develop education materials Develop post-session evaluation questionnaire
for participants
2 Recruit educator Prepare interim progress report for funder 3 Arrange the logistics of the education session
(venue, printing, facilitator,..)
3 Advertise for the education session 4 Deliver session 1 Collect completed evaluation questionnaire from
participants after session 1
Prepare interim progress report for funder
Analyze evaluation data
Prepare final report for funder
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 9 of 12
Evaluation
Please list the evaluation measures that you will use to evaluate the project and the sources of data required to report on these measures. We encourage applicants to develop a LOGIC MODEL for their proposed projects using the template provided in Appendix B (Optional). A LOGIC MODEL may assist the applicants to identify the important components of their project: the resources required to develop the project, the activities (what will be done), the participation (who will be reached), and the outcomes (the changes that the activities will result in). More importantly, A LOGIC MODEL can assist the applicants to easily define evaluation measures for their projects through which they can demonstrate the outcomes achieved by the projects and how they were achieved. Please refer to Appendix A which illustrates an example of a LOGIC MODEL and how it is being used in evaluation.
Please list the evaluation measures and how you are going to collect data to report on these measures.
Measure Data source/collection method Examples: Number of workshops conducted Project document
Number of participants who attended the workshops Project document
% of participants who reported after the workshop better understanding of the topic discussed
Post-workshop questionnaire
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 10 of 12
Budget Important Notes:
The total amount requested from the BC CPC, not including any cost sharing, MUST not exceed $5,000. Funds must only be used for the approved project. Grant funds MUST be used within one year of their start dates. Any unused funds will be recoverable by the BC CPC.
Please refer to Pages 8 of the Seed Grant Guidelines for use of the Award Money If the total direct costs exceed the amount requested, identify sources of co-funding and you may attach letters of commitment if available.
Anticipated Expenditures for the Project
ITEM Estimated Cost Funding Source
TOTAL ESTIMATED COSTS $
TOTAL COST by SOURCE OF FUNDING REQUEST TO BC CPC $
Other funding sources (please specify below)
$
$
$
TOTAL $
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 11 of 12
Appendix A: A LOGIC MODEL Example
INPUTS OUTPUTS
OUTCOMES
ACTIVITIES (WHAT WE PLAN
TO DO)
DEVELOP
TRAINING
MANUAL
DEVELOP
INFORMATION
PACKAGES
TRAIN
VOLUNTEERS
MARKETING
CONDUCT
WORKSHOPS
PARTICIPATION (WHO WE WILL
REACH)
PERSONS WITH
SERIOUS ILLNESS
FRAIL SENIORS
HOME HEALTH
CARE PROVIDERS
RESIDENTIAL
CARE PROVIDERS
FAMILY
CAREGIVERS
WHAT THE RESULTS ARE (In terms of
LEARNING/ACTION/CONDITION)
CHANGE IN:
LEARNING
AWARENESS
KNOWLEDGE
ATTITUDES
SKILLS
ASPIRATIONS
MOTIVATIONS
PERSON/FAMILY SATISFACTION
CONFIDENCE LEVELS
CHANGE IN:
END OF LIFE EXPERIENCE FOR
FAMILIES
QUALITY OF LIFE FOR PATIENTS
WHAT WE INVEST (REQUIRED RESOURCES)
INFORMATION/DATA
STAFF
VOLUNTEEERS
MONEY
PARTNERS
EXPERTS
EQUIPMENT
The Problem:
Family caregivers of
patients with terminal
illness often feel
physically exhausted
and emotionally
fatigued but they are
reluctant to leave the
bedside of their loved
ones because they do
not
want them to be
lone.
A Training manual developed
Brochure created
# Volunteers trained
# Brochures distributed
# Respite visits made
# Families who received respite services (by
type of service)
Families:
% Families who are aware of the availability
of respite services
% Families who feel comfortable to use
respite services
% Families who are satisfied with the service
received
Trained volunteers
Increase in level of knowledge about respite
care
Increase in confidence level to provide respite
care
# Families affected by the
problem
# Partners recruited
Partners ‘contribution
(cash and in-kind)
# (and profile) of experts
recruited
# of volunteers recruited
Suggested
Evaluation
Measures
Project Goal To provide respite for
family caregivers whose
loved ones are in their
final days of life
Objectives
Train volunteers to
offer vigil services;
Offer emotional support
by phone
Convening, Collaborating, Catalyzing to Create Capacity
Version Date: August 2016 Page 12 of 12
Appendix B: LOGIC MODEL Template
INPUTS OUTPUTS
OUTCOMES
ACTIVITIES (WHAT WE PLAN
TO DO)
PARTICIPATION (WHO WE WILL
REACH)
WHAT THE RESULTS ARE (In terms of LEARNING/ACTION/CONDITION)
WHAT WE INVEST (REQUIRED
RESOURCES)
The Problem:
Evaluation
Measures
Project Goal
Objectives