FMW SHIP 3 Letter of Intent.docx

8/22/2019 FMW SHIP 3 Letter of Intent.docx

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SHIP 3 Mini-Grant Applications

Letter of Intent (Non-Binding)

This letter of intent is a non-binding agreement between organizations

interested receiving a SHIP mini-grant (cooperative agreement) and Faribault,

Martin & Watonwan Counties SHIP Project. This letter of intent will become part

of your overall grant application, but does not guarantee your site will receive

funding. Additionally, information collected in the letter of intent will be used in

the following ways:

1. To aid in development of the FMW SHIP 3 Grant Application, due August30, 2013 to the Minnesota Department of Health; and

2. To develop a map of potential SHIP sites a requirement of the SHIP 3Grant Application submitted by Public Health to the Minnesota

Department of Health.

Upon completing the SHIP letter of intent, organizations will receive:

1. Information about applying for a SHIP mini-grant and/or as a SHIP site.Full application information will be provided to sites completing the letter

of intent during the week of August 12, 2013. SHIP mini-grants are

competitive and will require sites to develop a work plan and budget.

2. An assigned SHIP contact person who can answer questions related toallowable uses of SHIP funding while you develop your mini-grant

proposal.

InstructionsPLEASE COMPLETE THIS FORM ON A COMPUTER

(DO NOT HAND WRITE FORM)

1. Complete all boxes under section 1: Organization Information. Identifythe county(ies) impacted by the proposed work by checking the


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corresponding box. List each site/building that will be impacted by your

SHIP work separately and provide each sites address and demographic

information. Determine one point of contact per organization interested

in a SHIP mini-grant. One intent form PER organization is allowed. Please

include all the sites wishing to work with SHIP on one form.

2. Identify the strategy(ies) your organization would like to work on. Moredetailed information on each strategy can be found by accessing the Strategy Implementation

Guides at:http://www.health.state.mn.us/healthreform/ship/2013rfp/ Check the

corresponding box to each strategy your organization plans to apply to

work on. Within each of the strategies- select the sub-strategies your

sites plans to address. If you have an idea that is innovative or

considering a promising practice, please describe your innovative idea in

the next text box. Innovative ideas must be related to the strategy area

and must involve implementing a policy, systems or environmental

change.

3. In addition to the letter of intent, organizations must also submit a letterof commitment. The letter must be printed on your organizationsletterhead, should detail past work with SHIP and/or health improvement

and should confirm your organizations willingness to partner with FMW SHIP to work on theSHIP goals of:

a. Increasing the number of adults who are a healthy weight from 38% to 47% by 2020.b. Increasing healthy eating and active living in youth, specifically an:

i. Increasing the prevalence of youth who eat the recommended number of fruitsand vegetables daily from 18% to 30% by 2020.

ii. Increasing the prevalence of youth meeting moderate physical activityguidelines from 74% of boys and 68% of girls to 92% of boys and 89% of girls by

2020.

c. Decreasing young adults (18-24) who smoke from 27.8% to 18.6% by 2020.
http://www.health.state.mn.us/healthreform/ship/2013rfp/http://www.health.state.mn.us/healthreform/ship/2013rfp/http://www.health.state.mn.us/healthreform/ship/2013rfp/


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4. Complete this form and letter of commitment and send as an attachmentin an e-mail [email protected] LETTER OF INTENT FROM:(Your Organizations Name) in the subject heading. Letters of intent aredue no later than 5:00p.m. on August 9, 2013.

SHIP 3

Letter of Intent (Non-Binding)

1. Organization InformationOrganization Name:Contact PersonName/Title:

E-mail:Phone:
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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County(ies) impacted:(please check allcounties thisorganization will workin with SHIP

FaribaultMartinWatonwan

Site Name(please list site

name and address

if multiple sites,

please list all sites

and addresses i.e.-

multiple school

buildings, multiple

work sites, multiple

clinics, etc.)

Site Address Anticipated Numberof People Reached(i.e.- # of students,

# of staff, # of

community

members, #

patients in service

area, etc.):

Target PopulationsReached(i.e. % of youth, % of

low-income (free &

reduced lunch), %

uninsured, % Latino,

% population over

65, etc.):

2. We plan to apply for a mini-grant with SHIP in the following area(s):More detailed information on each strategy can be found by accessing the Strategy Implementation

Guides at:http://www.health.state.mn.us/healthreform/ship/2013rfp/

Strategy Area Sub-Strategy Innovative IdeasCommunity Nutrition Corner Stores

Menu Labeling

Farmers Markets

Innovative Idea:
http://www.health.state.mn.us/healthreform/ship/2013rfp/http://www.health.state.mn.us/healthreform/ship/2013rfp/http://www.health.state.mn.us/healthreform/ship/2013rfp/


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Community Gardens

Farm to Fork

Innovative Idea (Explain

in next box)

Active Transportation Complete

Streets/Pedestrian

Walkability & Bikeability

Joint Use Agreements

between recreational

facilities and

communities.


in next box)

Innovative Idea:

Healthy Schools Active Classroom

Physical Education

Recess

Before/After School

Safe Routes to School

School Garden

Farm to School

Concessions/Vending

A la Carte

Snacks

Classroom Incentives

Classroom Birthdays and

Celebrations

School as a worksite


in next box)

Innovative Idea:

Childcare Healthy Eating (LANA)

Physical Activity (IMIL)

Breastfeeding Support


in next box)

Innovative Idea


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Worksites Healthy Eating

Physical Activity

Breastfeeding Support

Tobacco Cessation


in next box)

Innovative Idea:

Health Care Community Clinical

Linkages

Advance Community

Linkages with State and

Federal Health Reform

Initiatives

Innovative Idea

Innovative Idea:

Smoke-Free Multi-Unit

Housing

Innovative Idea Innovative Idea:

FMW SHIP 3 Letter of Intent.docx

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