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Grants and Initiatives Application

 

New Hampshire Council for Children and Adolescents with Chronic Health Conditions

Grants and Initiatives APPLICATION: Organizations and Individual Projects

Organization Name

 N/A   501c-3YesNo
Applicant   Program  N/A
Website  N/A
Address
Primary Contact
Phone
Email
Project Title:
Project Start Date:  Project End Date:

Project Description

Describe the project   1) purpose, 2) targeted populations 3) numbers of people to be served, 4)   persons/ organizations involved, 5) plans and activities, 6) means of   evaluation, and 7) plans for dissemination of results or methods.

Project Budget ($100-$3,000)

Provide a detailed   projected budget including individual items, costs, with totals as well as   Project Total and Total Requested.    Example: Materials, 20 packets x $10 = $200; Staff, 15 hours x $10 =   $150, Travel, 50 miles x $0.55 = $27.50; Project Total = $377.50

Item Detail Totals
TOTAL REQUESTED
PROJECT TOTAL (total budget including all sources of   funds)

(Complete other side)

Describe how the indicated project would advance the   mission of the New Hampshire Council for Children and Adolescents with   Chronic Health Conditions. The Council for   Children and Adolescents with Chronic Health Conditions (CCACHC) was   established to:

  •       Promote the organized assessment of the   needs of children and adolescents with chronic health conditions and their   families.
  •        Serve in an advisory capacity to the   department of health and human services, department of education, and   insurance department for policy and program development.
  •       Collaborate with the department of health   and human services, the department of education, and other public and private   organizations statewide to enhance community-based family supports that meet   the unique needs of children and adolescents with chronic health conditions and   their families.
  •   Increase   awareness in the public and private sector of the medical, social, and   educational issues which impact children and adolescents with chronic health   conditions and their families.

State of New Hampshire Statute RSA 126-J

http://www.gencourt.state.nh.us/rsa/html/X/126-J/126-J-mrg.htm

 

 

Applications are accepted on a rolling basis and     reviewed for funding decisions within 90 days.  Fully completed applications will receive     notification of decision within 90 days.

Completed applications should be submitted to:

CCACHC at jeff@ccachc.org.

or mailed to the address provided by staff at 603-271-7045