Sample Overview – Full Proposal Application
Community + UCSF Mount Zion Awards: The following information is requested in the online application for a full proposal. This page is for planning purposes only. For requests without a community partner please submit online here; for requests with a community partner please submit online here; and for renewal requests with a community partner please submit here.
|MZ Campus – Applicant Name(s) and Title(s)||(If applicable) Community Partner(s) –
Applicant Name(s) and Title(s)
|Department/Division Name||Agency Name|
|Phone and Email||Phone and Email|
|Campus Address||Mailing Address|
|Alternate Contact(s) and Title(s)||Alternate Contact(s) and Title(s)|
|Name and email for Mount Zion Program Head (e.g., Chief of Service, Center Director, Division Chief, or Department Chair) to be contacted to verify that the UCSF partner is a Mount Zion-based program/faculty member/staff member|
|Project Title||Start and end date of requested grant period
(12/1/2021 earliest start; 7/1/2022 latest start)
|Total Project Budget
Total Amount Requested
|Amt Requested from MZHF payable to UCSF MZ(If applicable) Amt Requested from MZHF
payable to Community Partner(s)
|Executive Summary – briefly describe the project’s specific aims (3-5 sentences)|
- Explicitly benefits underserved communities. Describe the project and its purpose, including the unmet health need, target population, and the estimated unduplicated numbers to be served; explicitly state how the project advances the health of one or more underserved populations who have limited access to quality health services because of inability to pay, health status, race, religion, language, gender identity, or sexual orientation.
- Community Partnership. If the project includes a community partner describe (1) history of [or motivation for] partnership, (2) partnership roles of active collaborators from both organizations, (3) communications and decision making plans between partners for proposed project. If this is a pilot project that does not yet include a community partner, describe how the project plans to recruit, incorporate and leverage the effectiveness of a community partner into the project if the pilot is successful.
- Originates at, connects with, or relates to UCSF Mount Zion Campus. State how the project meets this geographical eligibility criteria in relation to UCSF Mount Zion.
- Embodies one or more of MZHF’s core Jewish Values. Articulate how the project embodies one or more of MZHF’s core values.
- Addresses health equity or other compelling San Francisco or UCSF Mount Zion healthcare priorities. Explain how the project addresses health equity or other compelling San Francisco or UCSF Mount Zion healthcare priority(ies) and list the specific goals (measurable outcomes) for the project numerically in order of priority. For each of the goals listed, provide a brief evaluation plan for collection of information (for example, using data from a patient survey or from metrics such as number of patients served) to facilitate MZHF’s assessment of project’s success in meeting its goals. Proposal must include a plan for evaluation with both quantitative and qualitative outcomes.
- Potential impact of the project is significant. Describe how the project demonstrates an innovative understanding or a solution to a compelling need and/or creates a model, mechanism or data others can employ.
- Team can successfully complete the project on time/budget. Provide a list of key project staff with qualifications, and a project timeline documenting plans to successfully complete the project on time/budget.
- Applicant can articulate plan for financial sustainability of project beyond the grant period. Articulate the plan for financial sustainability of the project beyond the grant period (if ongoing intervention is proposed).
- Include the following budget attachment(s):
- Total proposed project budget with justification, and including the following details: proposed grant period; line item breakdown of revenue and expenses; staff FTE commitments; specifically indicate the portion of the budget for which funding is requested from MZHF for UCSF Mount Zion; if applicable, specifically indicate the portion of the budget for which funding is requested from MZHF for Community Partner(s)
- Only for projects with Community Partner(s), please also provide from each Community Partner:
- Agency current year total budget (specify calendar or fiscal), with line item breakdown of revenue and expenses and staff FTE commitments
- List of committed, pending and proposed funders for the proposed project
- Board of Directors list
- IRS determination verifying 501(c)(3) status (submit only if not previously funded by MZHF)