Nursing Excellence Fund Grant Application

A Nursing Excellence Fund grant proposal must be submitted by the legally accountable party for the funds, for example, CEO, President, Executive Director.

Name of applicant organization*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Project name*

Amount requested*

Project contact name*

First NameLast Name

Position/title*

Email address*

example@example.com

Telephone number*

Each application will include the following supporting documents.

A. Name of entity/organization.
B. Description of organization:
i. Articles of incorporation;
ii. Mission statement;
iii. Financial overview/budget statements of organization;
iv. References related specifically to nursing involvement; and
v. An organizational chart.

C. Project name and narrative.
D. Project plan to include:
i. Goals and objectives;
ii. Measurable outcomes;
iii. Foreseen challenges/obstacles;
iv. Evaluation plan;
v. A detailed project budget, to include all revenue sources, the organization's prior year's financial audit, timelines to meet goals/objectives and the use of awarded funds; and
vi. Project director or contact person (include name, title, work address, phone, email).

E. Recipients shall submit any other documentation requested by agency staff at any point during the application or execution of the project.

Upload proposal*

I affirm the following:

We have attached all documents as required and attest that these are true and reliable submissions regarding our intent to applyfor funding from the Nursing Excellence Fund.
We agree to submit a minimum of one report at the end of the award year at a regularly scheduled Board of Nursing meeting. We also agree to submit any interim reports as requested by the Board.
I am the legally accountable party for the Nursing Excellence funds.

By digitally signing below, I attest that all the information provided in this webform is true, accurate, and complete to the best of my knowledge. I understand that any false or misleading information may result in consequences as determined by applicable laws and regulations. I acknowledge that the digital signature is my legally binding electronic signature for this document.

Submitted by (name)*

First NameLast Name

Position/title*

Telephone number*

Please enter a valid phone number.

Email address*

example@example.com

Signature