2012 Application
 
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Gilbert Application 2012

Gilbert Application 2012

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The Rosalinde Gilbert Innovations in Alzheimer's Disease
Caregiving Legacy Award

2012 APPLICATION 

 

INSTRUCTIONS

In addition to reading the Eligibility and Submission conditions on the General Information page, please take note of the following before you submit your online application:

  1. All fields are mandatory. Incomplete applications will not be considered.
  2. The application form will not do a word count for you. You need to do your own count in a Word document and copy and paste the text into the appropriate boxes. Applications exceeding the maximum word count allowed for each question will not be considered.
  3. You can save your online application by clicking on "Save my progress and resume later" at the top and bottom of each page. You will be asked to sign in and create a user name and password. To resume working on it at a later time, simply return to the application homepage and click on "resume a previously saved form."
  4. When you are ready to submit your application, click "Submit" on the bottom of your screen. Once you hit "Submit", you will have the opportunity to review and make edits, if necessary, to your anwers before finalizing the submission. You finalize the submission of your application by clicking the "Confirm" button located at the bottom of your screen.
  5. Remember this is an award, NOT a grant application.
  6. The deadline for application submissions has been extended to September 14, 2012 by 5:00 p.m. (Pacific Time).
  7. If you have additional questions, feel free to send us an email at [email protected] 
Thank you and good luck!
CONTACT INFORMATION
Applicant Information




Organization Information








Program/Project Information



Choose only one

3. Please provide an abstract of your program/project.  The abstract should contain information on the following:

  1. Program/project goal(s)
  2. Program/project rationale
  3. Population served
  4. Specific activities
  5. Results/product

 

Maximum 150 words
BACKGROUND
Organization

4. Tell us about your organization. Provide the organization's website address if applicable.

Maximum 150 words
Program/Project

5. Describe your program/project. Provide the project-specific website if applicable. Be sure to include the following information:

  1. What was the cost of your project/program?
  2. How long did your program/project last? When did it start and when did it end? Is it ongoing or does it occur in cycles?
  3. Who were the participants or target groups in your program/project? If it was a performance or outreach or advocacy effort, who was the audience or the population you were trying to impact or influence?
  4. How are family caregivers impacted by your program/project?
  5. How many staff and/or volunteers worked to implement this program/project? What types of involvement did staff and volunteers have?
  6. Did you collaborate with any other groups or individuals? If so, who were they and what did those collaborations and interactions involve?
Maximum 400 words
PROGRAM/PROJECT EVALUATION
Rationale/Purpose

6. What is the need you are/were addressing with this program/project? Why did you focus on this particular population at this particular time?

Maximum 200 words
Innovation

7. In what ways is your program/project innovative or unique? For example, does it:

  1. Respond to an unmet need in your community?
  2. Build on prior experience/research?
  3. Adapt an existing program/project to a new community (e.g. ethnic, rural, LGBT, young caregivers)?
  4. Incorporate innovative collaborations?
Maximum 200 words
Impact

8. How has your program/project impacted the community you were aiming to serve?  What are the indicators of your program’s success?  Examples of information might include:

  1. Number of participants/ target groups reached.
  2. Results from formal evaluation.
  3. Legislation introduced.
  4. A statement of goals; how you did or did not reach those goals; how you may have redefined them as the program/project progressed.
Maximum 200 words

9. Please illustrate how your program/project affected an individual caregiver.

Maximum 150 words
Replication/Dissemination

10. Can your program/project be replicated or have continued use? If so, what are the major components needed for replication or dissemination? Are there materials that are key elements of this project? If your project was a policy or advocacy initiative, what circumstances existed to allow your project to move forward?  What lessons did you learn? 

Maximum 200 words
Proof of non-profit status

NOTE: Other than proof of your nonprofit status and your online application, do not provide any additional materials at this stage of the application.You will be contacted if additional materials or information are needed. If not attached to this application, you can email a copy of your nonprofit designation letter to [email protected] or mail it to: Family Caregiver Alliance, Attn: Awards Program, 785 Market Street, Suite 750, San Francisco, CA 94103. If you are using this option (i.e regular or electronic mail), please be sure to include your contact information, as it appears on this application including applicant's last name, so we can match your letter to your application.

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phone: (415) 434.3388 . (800) 445.8106 . fax: (415) 434.3508 . 		 

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