OMB Approval No. 0~043 APPLICATfON FOR 2. DATE SUBMITTED Applicanllder -·er

FEDERAL ASSISTANCE April 13, 2004 J?A# 04164 1. TYPE OF SUBMISSION: 3. DATERECEIVEDBVSTATE State Application Identifier

Appi;calion Preappliczllion r~ r Constn.clicn 4. DATe RECEIVeD BY FEDERAl. AGENCY Fedelalldentifier

r~Ciion I>( S. APPUCANT INFORMAnON

Legal Name: Organizationaluntt

Save A Life Foundation .Aclclnm (glw ely. COUIII)', uto, IMifl ZiP r:«/of. Nam!J an<SIMpl1oM numb8l' oiii'IO porscn 10 bo con1a1:1oc1 on matlflrs Involving 1t11s Oflllliealiclft

O'Hare Aerospace Center (givP /!IIJII C<Kio}

9950 West Lawrence Ave. Ste #300 carol J. Spizzirri President/Founder Schiller Park, Illinois 60176 (847) 928·9683

S. BIPLOYER IDf:HnFICAT&ON NUMBER (EJN): 7. TYPE OF APf>UCAHT: (en tor apptDpdara 111!11/r In box} [;] ~-·

A. Slate H. IMepenclotrl School Oist. &. TYPEOFAPPUCAnO~ B.Ccunty I. StaCa Con:tacodlnsi!Mian ol HigMt Laaming

~Now r ConllnrmUon r Revision C. Mtll\lcipal J . Pr\vala 1Jniv4rally D. Township K.tndianTdb&

0 D E. tntersllllo '- lndMdual U Revision. enutt apptgpllalo IDUarts) in box(os}: F. lmomwnlc:ipal M. Ptolil Organimtion

G. Spada~ Distll;l N. Othar {Spst:;ily):

A. lnc:roiiSo Awan! B. Oecmau Awanl c. Increase OuteliOn 0. Ooc:nia.se Duntlion Othur (sptiCi!yj: 9. NAME OF FEDERAL AGENCY:

Centers For Disease COntrol & Prevention

10. CATALOG OF FEDERAL DOMESTIC 11. DESCRIPTIVE TITLE OF APPUCANT'S PROJECT: ASSISTANCE NUMBER: rn-1 I I I Expand The Training Of Basic Life

Support and Emergency Preparedness nnE; Skills, especially to children

12. AREAS AFFECTED BY PROJECT (CiliD$. COUIIIias, Sla!H,IIIC.):

IL, WI, NC, NY, FL, PA,

13. PROPOSED PROJECT: 14. CONGRESSIOtlAL DISTRICTS OF: Stan Date EncfmgData a. Appttcant .b. ProJect

06/01/04 05/31/05 Cook County, IL - Dist. Earmark for Save A Life ll,lO,lS,l4, 19 Foundation

15. ESTIMATED FUtlDING: 11. ISAPPUCATION SUBJECT TO REVII:W BY STATE EXEcunVE ORDER 12372 PROCESS?

a.. Federal $ .00 a. YES. m5 PREAPPIJCATIONIAPPUCATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE 1,005,000 ORDER 1Z372 PROCESS FOR REVIEW ON:

b. Applicant $ .00 DATE

c. State $ .00

d. Local $ .00 b. NO.j5( PROGRAM IS NOT COVERED BY E.O. 12372

e. Other $ .00 r OR PROGRAM HAS NOT BEEN SELECTED STATE FOR REVIEW

f. Program Income $ .00 17. IS APPUCAnON DEUNOUENT ON ANY FEDeRAl.. DEST?

rves II "'M.: altllell an Ul)lallaUOn. r g. TOTAL $ .00

1,005,000 18. TO THE BEST OF flY KNOWI.SCGE AND 8l!UEF, ALL DATA IN THIS APPIJCAnONIPREAPPUCATlON ARE TRUE AND CORRECT, THE OOCUMEHl' HAS BEEN DULY AIITHORIZCO BY THE GOVERNIHG BODY OF THE APPUCAHT AND lHE APPUCANT WILL CO!IIPI. Y wmf TME ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.

a. Typed Natne of Authorized Representative b. nue c. Telephone number

~arol J. Spizzirri President/Founder 847-928-9683

Sltr~~:p~ntative ?lf !~ ~JJt#~ j e. Date Signed

04/13/04

Pre~ Editions ~~~sab~~~ ,W I StandatO Form 424 (Rev. 7·97) Authorized for Local eprodu ton Prescribed by OMS Cilt:ular A·102

PHS-5161-1 {7/00) PagelS

CHECKLIST OMB Approval No. 0920-0428

Public Burden Statement: Public reporting burden of this Clearance Officer, 1600 Clifton Road, MS D-24, AUanta, GA 30333, collection of Information Is estimated to average 4 hours per ATIN: PRA (0920-0428). Do not send the completed form to this re~~nse. including the time for reviewing in:;tructlons, searching address. ex~sling data sources. gathering and maintalmng the data needed, and completing and reviewing the collection of infonnation. An NOTE TO APPUCANT: This form must be completed and agency may not conduct or sponsor. and a person is not required to submitted with the original of your appfacation. Be sure to complete respond to a collection of Information unless it displays a currently both sides of this form. Check the appropriate boxes and provide valid OMB control number. Send comments ~arding this burden the Information requested. This form should be attached as the last estimate or any other aspect of this collection of information, page of the signed original of the application. This page is reserved including suggestions for reducing this burden to CDC, Project for PHS staff use only.

Type of Application: ~NEW Noncompeting Competing r Continuation r Continuation r Supplemental

PART A:. The following checklist Is provided to assure that proper signatures, assurances, and certifications have bean submitted.

Included NOT Applicable

1. Proper Signature and Date for Item 18 on SF 424 (FACE PAGE) ........................... .. 2. Proper Signature and Date on PHS-5161-1 •certifications• page ...................... ...... . 3. Proper Signature and Date on appropriate "Assurances• page, i.e.,

SF-4248 (Non-Construction Programs) or SF-424D (Construction Programs) ......... 4. If your organization currently has on file with DHHS the following assurances,

please identify which have been filed by indicating the date of such filing on the line provided. (All four have been consolidated into a single fonn, HHS Form 690)

IX !X

IX Civil Rights Assurance {45 CFR 80) ...................... ............. ..... -----------IX Assurance Concerning the Handicapped (45 CFR 64 ) .. .......... ------------~ Assurance Concerning Sex Discrimination (45 CFR 86) ......... ------------IX Assurance Concerning Age Discrimination (45 CFR 90 &

45 CFR 91) ...................................................... ..................... .. 5. Human Subjects Certification, when applicable {45 CFR 46) .................................... . r

PART B: ThJs part Is provided to assure that pertinent Information has been addressed and Included In the application.

r

NOT YES Applicable

1. Has a Public Health System Impact Statement for the proposed program/project been completed and distributed as required? ............................................................. ..

2. Has the appropriate box been checked for item# 16 on the SF-424 (FACE PAGE) regarding intergovernmental review under E.O. 12372? (45 CFR Part 100) .............. .

3. Has the entire proposed project period been identified in item# 13 of the FACE PAGE? ..................................................................................................................... .. .. .

4. Have biographical sketch(es) with job description(s) been attached, when required? ......................................................... ........................................... ................... .

5. Has the "Budget Information• page, SF-424A (Non-Construction Programs) or SF-424C (Construction Programs), been completed and included? ........................... .

6. Has the 12 month detailed budget been provided? .............. .. ........ - ..................... ... .. .. 7. Has the budget for the entire proposed project period with sufficient detail been

provided? .................................................. ............... ............................... ................ ..... . 8. For a Supplemental application, does the detailed budget address only the additional

funds requested? .................. ... .... ..... ....................... .............................. ............ ..... ..... . 9. For Competing Continuation and Supplemental applications, has a progress report

been included? ..................... ....................................................................................... .

PART C: In the spaces provided below, please provide the requested Information.

r j)(

P<

r IX )X

IX r r

r r IX

IX

Business otriCial to be noli1'1ed if an awam is to be made. Program Director/Project Direc:!ar/Principallnvestigator designated to dlr&cllhe orcoosed DrOiect or DIOOtam.

Name Carol J . Spizzirri

nue President/Founder

OtgantzaUon Save A Life Foundation

9950 West Lawrence Ave. Ste#300 Add~s Schiller Park, IL 60176

E~au~5 carol®salf.org

Telephono Number ( 84 7) 928 - 96 83

Fax Number ( 8 4 7 ) 512 9 - 9 6 64

Name Carol J. Spizzirri

nuo President/Founder

Organization Save A Life Foundation

9950 West Lawrence Ave Ste #300 Add~ Schiller Park, IL 60176

E-mail Address carol®salf. org

Telephone Number { 84 7} 92 8-96 83

Fax Number ( 84 7} 9.2 8-96 84

APPUCAHT ORGAHIZAnON'S 12-0IGIT DHHS EIN (If atrcacl)' as~sno"' SOCIAL SECURITY NUMBER HIGHEST DEGREe EARNED

c c I J ~ RN BS (OVER]

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

PUBLIC HEALTH SERVICE

GRANT APPLICATION

For use by: • State and Local Government Applicants • Nongovernmental Applicants for Health Services Projects

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FORM PHS-5161-1 (Revised 7 /00)

.. ) j

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Centers For Disease Control

and Prevention (CDC)

Carol Spizzirri, President/Founder Save-A-Life Foundation, Inc. 9950 West Lawrence Ave Suite 300 Schiller Park, IL 60176-1216

Reference: PA# 04164, Earmark for Save a Life Foundation

Dear Ms. Spizzirri:

y;: ~-.

The Save-A-Life Foundation has been identified to receive a CDC assistance award for approximately $1,018,829. The budget period is expected to be from June 1, 2004 through May 31,2005. Although you were funded a grant award under another program announcement, you will receive a new one-year award under Program Announcement Number 04164.

The purpose of the earmark funds is to evaluate the effectiveness ofthe Save-A-Life training program and to implement and expand state training sites to a national training capacity. This funding will be used for all costs associated with expansion of training sites and evaluating the program.

In order to process the award~ you must submit an application package. This letter is designed to provide the guidance required to prepare the application package. Please read and follow all the instructions below.

The application package must arrive this office no later than April 16, 2004. The application packet should consist of an original plus 2 copies of the following:

• Cover Letter that includes the names of the program director/principal investigator's (PI) and business offic~al's name, title, complete mailing address, phone number, and email address. Also, provide a point of contact name ofperson who prepared the application package, if different from PI.

PHS Form 5161. To obtain instructions and a tillable .copy of this form on line, visit the following website: http://www.psc.gov/forms/FF99/PHS-5161-llphs-5161-l.html. Clearly reference the PI ogram Announcement number on the application. Number all pages including appendices. Print on only one side of each page. Use single spacing. Do not staple or bind your application

·)

• SF 424. Within the website for the PHS Fonn 5161 are the SF 424's. Ensure the amount entered on the SF-424 matches the Budget Narrative and detailed budget.

2

Important Note: Be sure to include the complete EIN for your organization, including the two-digit suffu:. If you have never applied for assistance and do not have an EIN, please be sure to note that in your cover letter. Also, you are required to have a Dun and Bradstreet Data Universal Numbering System (DUNS) number to apply for a grant or cooperative agreement from the Federal government. Your DUNS number must be entered on the face page of the application form next to the EIN. The DUNS number is a nine-digit identification number, which uniquely identifies business entities. Obtaining a DUNS number is easy and there is no charge. To obtain a DUNS nwnber, access www.dunandbradstreet.com or call 1-866-705-5711.

• Program Narrative. The following information is provided to assist you in preparing your program narrative:

-Program Goals and Objectives. Provide a plan of action that describes the proposed program objectives and activities for the upcoming budget period. Each activity should lead to the accomplishment of the proposed objectives. Each

, objective must contain a performance or outcome measure that assesses the effectiveness of the project. The applicant should adequately describe how it would implement the program activities and disseminate the outcomes of the activities and services provided. The application should include a detailed timeline for each accomplishment.

-Program Requirements.

• Detailed budget and justification. Up to $1 ,018,829 is available to fund this award. Please prepare a budget that does not exceed this amount (including direct and indirect costs). A sample budget template is located at the following website: http://www .cdc. gov/od/pgo/fundinglbudgetguide.hnn.

• Indirect Rate Agreement. Enclose a copy of your organization's most current negotiated Federal indirect cost rate agreement. Note: Unless a cost rate agreement has been federally approved by the Division of Cost Allocation, all budget items should be direct costs.

• Other Information: Final Progress Report (within 90 days after the end "of the project period) Final Financial Status Report (within 90 days after the end of the project period)

Applications may not be submitted electronically at this time. Please mail application packet to the following address:

Angie Tuttle, Grants Management Specialist Acquisition and Assistance Branch A Centers for Disease Control and Prevention 2920 Brandywine Road, Mailstop K-75 Atlanta, GA 30341-4146

If you need any programmatic guidance, please contact J acqui Butler by telephone at (770) 488-1496 or by email at JAButler@cdc.gov. If you need any budget guidance, please contact me by telephone at (770) 488-2719 or by email at aen4@cdc.gov.

cc: Robin Forbes

Sincerely,

AJT~ Tuttle

G anagement Specialist Acquisition and Assistance, Branch A Procurement and Grants Office

3

. ·· . \

SALF'

Carol J. Spizzirri Founder I President

Save A Life Foundation

Tuesday,Apnl13,2004

Angie Tuttle Grants Management Specialist CDC Centers For Disease Control & Prevention Acquisition and Assistance Branch A 2920 Brandywine Rd, Mailstop K Atlanta, GA 30341-4146

DUN# 08-092-0437

Re: Program Announcement PA #04164 Earmark for Save A Life Foundation

National Headquarters 99SO W. Lawrence Ave Ste 300 Schiller Park, Illinois 60176-1216 Ph: (847) 928-9683 F:u: (847) 928-9684 Toll Free: (888) 892-0606 Website: www.salf.org

Grant title: Expand The Training Of Basic Life Supporting and Emergency Preparedness Skills

Dear Ms. Tuttle:

Save A Life Foundation is a 501 C (3} organization dedicated to working with the public health infrastructure to ensure the creation of a safety net for everyday citizens in the their communities. We train citizens in life supporting first aid skills, with a particular focus on children (K-12} in age appropriate programs that include i.e., Heimlich Maneuver, CPR, bleed control, blood borne- bio hazardous precautions, access EMS, deployment of AED's_ Since 1997 SALF has trained nearly 1 million children in Illinois, moving into Wisconsin in 2003 and are about to expand our system of training into even more emergency and public health departments which SALF establishes its branch sites_ Using their local emergency medical service providers as our instructors we are able to train children K-6th grades our Save A Life For Kids program (1 hour), and 7th to 12th graders our Bystander Basic program (2 hours) with remarkable success, both in skills retention and increased willingness by these same students to aid the injured or ill at a time of an emergency. The proof of this accomplishment is due to our web base data collection system participated by each student.

GRANT ACTIVITIES In order for SALF to expand its base site in each targeted state SALF must:

- Locate a hospital to home a branch Find and train an individual with EMS credentials to serve as a Facilitator Obtain support from a physician to serve as Project Medical Director Obtain support of local mayors to establish a Citizen Corps Council and apply for funds to support the school training · Identify EMS providers and train as instructors Identify local corporations willing to Adopt A School to defer training costs Identify schools, schedule classes between schools and Instructors Evaluate class and test students for skills proficiency

Each Instructor receives compensation for their travel and time which aids greatly in supplementing their meager professional income while off duty.

Page2 Save A Life Foundation April 13, 2004

Over the years SALF has been embraced by many including being the second affiliate of the U.S. Homeland Security's Citizen Corps in January 2003, Illinois Homeland Security's Terrorism Task Force, 2001 and alike. Our partners include the U.S. Conference of Mayors, State Municipal Leagues, Chicago Bar Association, Chicago Public Schools, Global Ronald McDonald's House Charities, and so forth.

My greatest pleasure besides seeing the children's faces as they discover their new ability to save a life, working with CDC since 2001, is serving with Dr. Peter Safar (Father of CPR) and Dr. Henry Heimlich (Heimlich Maneuver) SALF's founding Medical Board, to train the critical mass should they faced an emergency.

Everyone has a emergency role. The "Pre-EMS" role is the most crucial in maintaining life until advance EMS arrives. SALF feel fortunate that CDC feels the same.

encl.