Srere Women's Care Fund - Sinai-Grace Hospital

SRERE WOMEN’S CARE FUND

Application Process
Midtern and Annual Report Form

Application Click here for a printable application form

(note: This form can be filled online and then printed)

Dear Health Care Provider:

Through a generous donation from the Srere family, a fund was created in 1998 to benefit mothers and infants receiving care at Sinai-Grace Hospital. The intent of this grant process is to create or enhance programs and services for these underserved individuals. The new programs and services could include, but are not limited to, new or expanded services in community outreach, health screening, community-based health education, home health nursing, and various social work programs. It is anticipated that approximately $50,000 will be available annually to fund several small grants. The committee will, however, individually consider any meritorious application for additional funding or time extension.

The Fund is open to all non-profit 501(c)(3) organizations and other non-profits certified as tax exempt under the IRS code. Funding priorities are:

Health care and social welfare needs of women and their infants in the Northwest Region of the DMC.
The health care needs of vulnerable/at-risk populations.
Programs that address uninsured or underinsured women and infants.

The Fund gives priority to requests for:

Start-up or short term operating support.
Programs with a defined period that address a critical need.
Geographical priority to the Northwest Detroit metropolitan area.
Programs that enhance access to care.

Preference will be given to proposals that:

Have a specific plan for continuation funding beyond the grant period.
Include a financial or in kind contribution from the organization.
Involve collaboration with others.
Have a well-defined outcome based evaluation plan.

The Fund generally will not consider support for:

Grants made directly to individuals.
Loans.
Grants to support religious activities or sectarian education.
Overseas projects.
Endowments, annual fund drives, fundraising events.
Past operating deficits

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SRERE WOMEN’S CARE FUND

APPLICATION PROCESS

The Srere Women’s Care Fund (SWCF) committee will review all proposals and materials. Those proposals which appear to be in compliance with the Fund’s philosophies will be considered.

II.

Grants will be distributed by the SWCF annually. The grant application, together with any attachments, should be submitted to the Department of Obstetrics and Gynecology, Sinai-Grace Hospital, by December 1st of each year. (Emergency requests may be considered on a case by case basis.)

III.

The SWCF committee will review each application after December 1st. Successful applicants will be notified no later than February 1st.

IV.

Complete all the information requested in the grant application. Incomplete Grant Requests Will Not Be Accepted.

Complete and submit the SWCF Cover Sheet. It is necessary to include a contact person should questions arise or a site visit be necessary.

VI.

Proposals should be limited to no more than five (5) numbered pages using the format listed below. The entire application, including letters of support and attachments, must be limited to no more than ten (10) pages total.

Statement of Problem and Need – Explain the need for your project, target population to be served, problems to be addressed, and anticipated benefits.

Project Description

1.	Purpose – State the purpose of your project.
2.	Goals and Objectives – Outline your project’s goals and objectives. List desirable, measurable outcomes and indicate whether this is a new or existing project
3.	Strategy and Implementation Plan – Describe the proposed services, how they will meet your objectives and why this approach has been selected. Note ages of your target populations, geographical area, and current and/or projected number of new individuals to be served. Please include a timetable of implementation activities.
4.	Evaluation – Explain how the success of your project will be defined and measured. Indicate who will perform the evaluation and describe how the results will be used and disseminated. Include examples of past program evaluations if this is an existing program and examples of evaluation tools if available.
5.	Budget – Provide a detailed project budget including expected revenue and expenditures for the identified grant time period. If the request is for equipment, please include verification of the equipment cost. Indicate the level of support requested from SWCF, the hospital’s contribution and other existing funding sources. Please state if your project has been reviewed by the hospital as part of its regular budgetary process. If applicable to your proposal, explain how this program was funded in the past and why funding has been or will be terminated. Dollar amount of grant support requested and the proposed time period for use of these funds Detailed budget for the project, identifying the proposed use of SWCF grant funds and any additional support anticipated from other funders or the applicant Provisions for future project funding beyond the initial grant period
6.	Continued Financial Support – State plans for securing continued support for the project following the grant period and explain how you intend to integrate the project into the core services of your organization.

VII.

Letters of Support – Please include letters of support from those organizations whose cooperation is integral to the success of the project and/or whose testimony supports the proposal as a sound approach to achieving your goals.

VIII.

Tax Exempt Status – If project is outside the auspices of the Detroit Medical Center, include copy of 501(c)(3) certificate.

IX.

Timeline – In order to receive consideration, all proposals must be postmarked or hand-delivered no later than December 1st to the Department of Obstetrics and Gynecology, Sinai-Grace Hospital (6071 West Outer Drive, Room M541, Detroit, MI 48235).

Presentations – Each grant requester will be scheduled for a presentation of no more than 15 minutes, including questions and answers. Presentations will be scheduled for the first part of January. Times will be distributed to the contact person by December 15th.

XI.

A midterm report must be submitted during the grant year and is due May 15th. A final report must be submitted to the SWCF at the end of the grant year and is due December 1st. The reports are to be sent to Srere Women’s Care Fund, Department of Obstetrics and Gynecology, Sinai-Grace Hospital, 6071 West Outer Drive, Room M541, Detroit, MI 48235.

XII.

If the grant is not used within one year of award, it will be considered void and returned to the Srere Women’s Care Fund.

SRERE WOMEN’S CARE FUND

COVER SHEET

1. Name of Applicant Organization:

2. Street Address:

3. City/State/Zip:

4. Phone #:

(____)____________

Fax #:

(____)____________

5. Contact Person:

Title:

6. Email Address:

7. Project Title:

8. Request for Funding:

New

Contribution

9. Project’s Operating Budget:

10. Anticipated Contribution From Other Sources:

11. Amount Requested:

12. 501(c)(3) Documentation:

DMC Request

Enclosed

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SRERE WOMEN’S CARE FUND

Midterm and Annual Report Form

Name of project and a brief description.

II.

Evaluation of Program Activities and Achievements

A.	List the activities that have taken place to date.
B.	List your goals/objectives and related achievements for each.
C.	Explain achievements that exceeded or were below projections.
D.	Comment on the most significant successes.
E.	Comment on disappointments.
F.	Comment on lessons learned.
G.	Explain how the program has improved the quality of life of those served.
H.	In what way is the program innovative? Indicate N/A if not applicable.
I.	Indicate who your collaborating partners are. Indicate N/A if not applicable.
J.	In what ways, if any, have you involved consumers in the program’s development or implementation?

III.

Budget Performance

A.	List program expenditures for this year.
B.	How did expenditures compare with projections? Explain if expenditures exceeded or were below expectations.
C.	Have you received other future funding for this project?

IV.

Srere Women’s Care Fund Recognition

A.	In what ways did you recognize the Srere Fund as a benefactor for your project?
B.	Please include any articles published, news clippings, pictures, news releases, brochures and any other appropriate material.

The Annual Report must be received before any additional grants will be considered.

The midterm and final reports are to be mailed to:

Midterm reports are due May 15th and annual reports are due December 1st.

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