- Diabetes Treatments

Project Diabetes Program Implementation Grant Application
Application Guidelines

State of Tennessee
Center for Diabetes Prevention and Health Improvement

NEW PROJECTS ONLY

One original, 4 complete hard copies, and one electronic copy of your
application must be received in the Center for Diabetes Prevention and
Health Improvement office designated below by 2:00 PM CT on October 22,
2008 Incomplete or late applications will not be accepted Applications
may be hand-carried or mailed to the address below Faxed submissions will
not be accepted

Laurie Stanton, MS, RD
Application Coordinator
Director, Child Nutrition and Wellness
Department of Health
Cordell Hull Building - 5th Floor
425 5th Avenue North
Nashville, TN 37243
Telephone: 615-532-8192
Facsimile: 615-532-7189
Email:
lauriestanton@statetnus

Table of Contents

Introduction 3
I Project Diabetes: Overview and Purpose 4
II Eligible Applicants 6
III Availability of Funding 7
IV Funding Priorities 7
V Appropriate Use of Funds 7
VI Guidelines for Project Diabetes Implementation Application Submission
8
VII Application Review Process 15

APPENDICES 16
A Progress Report Guidelines 17
B Application Cover Page 20
C A Guide to Writing Project Objectives 21
D Grant Budget Forms Form A and Form B Samples 23
E General Assurances Form 26

Application Package Checklist 27
Summary of Grant Timeline 28

Excel Spreadsheet for Budget Separate Excel File Entitled Budget
Formatxls
Project Diabetes Program Implementation Application
Availability of Funds
Application Guidelines

The Tennessee Center for Diabetes Prevention and Health Improvement the
Center will make funds available to support implementation of innovative,
evidence-based programs focused on the prevention and/or treatment
of
diabetes pursuant to TCA Title 4, Chapter 40, Part 4 The purpose of the
Center is to develop and promote a statewide effort to combat the
proliferation of Type 2 diabetes As part of this effort, the Center
intends to provide program implementation grants to providers of primary
and specialty health care services related to the development of programs
for prevention and treatment of pre-diabetes and diabetes

Competitive proposals must include a sound program design, a program budget
that supports the program design, strong performance measures, and a plan
to support activities of the program when grant funding is no longer
available Rationale, significance, and need for the program; a description
of potential impact of the program; availability and population
characteristics of program participants; appropriate plans for recruitment,
outreach, and follow-up; anticipated program challenges; and comprehensive
evaluation plan with a clear sustainability component are required

Primary and specialty providers of health care services related to the
prevention and/or treatment of obesity, pre-diabetes and diabetes are
eligible to apply All community and faith-based organizations,
regional
and county health departments, clinics and other for-profit or not-for-
profit health-related providers are eligible to apply In order to be
eligible for a grant, an entity shall demonstrate evidence of financial
stability, utilize evidence-based practices, and show measurable results in
its programs

In distributing grant funds, the Center will make every effort to create a
coordinated, statewide set of resources to assist the citizens of Tennessee
in their efforts to prevent development of diabetes through risk reduction
or to treat patients previously diagnosed with diabetes

Successful applicants will be required to submit a quarterly progress
report to the Center during the term of the grant funds awarded through
this application process The report should reflect progress toward stated
program goals and must be submitted according to the attached Quarterly
Report Guidelines Appendix A

The anticipated grant period for funding awarded through this application
process is March 1, 2009 through February 28, 2010

I Project Diabetes: Overview and Purpose

Project Diabetes is a Statewide initiative focusing on innovative
education, prevention, and treatment programs
for diabetes and obesity
Fundamental goals of Project Diabetes are to:

Decrease the prevalence of overweight/obesity across the State and, in
turn, prevent or delay the onset of Type 2 diabetes and/or the
consequences of this devastating disease
Educate the public about current and emerging health issues linked to
diabetes and obesity
Promote community, public-private partnerships to identify and solve
regional health problems related to obesity and diabetes
Advise and recommend policies and programs that support individual and
community health improvement efforts
Evaluate effectiveness of improvement efforts/programs that address
overweight, obesity, pre-diabetes, and diabetes
Disseminate best practices for diabetes prevention and health
improvement

Why diabetes and obesity?
Despite rigorous scientific evidence that Type 2 diabetes can be postponed
or prevented with lifestyle modifications particularly physical activity
and dietary choices and standard therapies, it has reached epidemic
proportions in the United States According to the Centers for Disease
Control, almost 21 million Americans have diabetes,
and another 54 million
have pre-diabetes Diabetes is now the leading cause of adult blindness,
end stage renal disease, and lower extremity amputation These alarming
statistics are due in large part to the obesity epidemic sweeping our
nation - obesity is a major risk factor for diabetes The relationship
between obesity and diabetes creates an especially acute burden for
Tennesseans

The prevalence of diabetes and obesity in Tennessee has increased steadily
since 1997, when it was reported to be 4 By 2001, approximately 8 of
adult Tennesseans were diagnosed with diabetes compared to 65 nationwide
Diabetes prevalence rates are directly related to education levels: 5 of
adult Tennesseans with post-high school education are diagnosed with
diabetes compared to 9 of those with high school degrees and 13 of those
having less than a high school education[1] In Tennessee, 91 of adults
ages 45 to 64 have type 2 diabetes - the highest prevalence in the United
States for this age group[2] In 2003, diabetes was the 6th leading cause
of death in Tennessee and the 4th leading cause of death for African-
Americans[3] Overweight and obesity have steadily and significantly
increased in Tennessee
- 501 of adult Tennesseans had a BMI 25 in 1996
compared to 641 of adults with a BMI 25 in 2004 If this trend
continues, the prevalence of overweight/obese adults in Tennessee will be
721 by 2010[4] Studies have found that a weight gain of 11-18 pounds
increases a persons risk of developing Type 2 diabetes by two-fold[5]
The diabetes crisis in Tennessee is not limited to adults According to a
recent study conducted by the Trust for Americas Health, Tennessee ranked
second highest among all states in overweight high school students at
152 In 2001, 61 of Tennessee high school students participated in
physical activities on three or more of the past seven days Such
participation was significantly higher among males 71 than females
51 The prevalence of risk reducing physical activity declined with
increasing grade level such that 66 of 9th graders, 62 and 63 of 10th
and 11th graders, respectively, participated in this level of physical
activity, and only 54 of 12th graders exercised to these levels[6] The
adolescents of today will become the adults of tomorrow, making this
population of critical importance in developing policies to improve the
health of Tennessee
Beyond the
significant impact of obesity and diabetes on the quantity and
quality of life, Type 2 diabetes is associated with a significant economic
burden for families, payers of health care and the citizens of Tennessee
Tennessee spent approximately 315 per person in 2003 on medical costs
directly related to obesity, the sixth highest in the United States[7] For
people with diabetes, per capita annual costs of health care rose from
10,071 in 1997 to 13,243 in 2002, an increase of more than 30 percent In
contrast, health care costs for people without diabetes amounted to 2,560
in 2002[8] The financial costs for diabetes and obesity are increasing
and significantly threaten a healthcare system already strained by
decreasing cost sharing with employers
Why the need for innovative diabetes prevention and health promotion
initiatives?
Studies indicate the quality of diabetic care in the US is sub-
optimal[9], and few patients 10 are treated to recommended therapeutic
targets for blood sugar, blood pressure, and lipids - critical clinical
indicators for prevention of micro- and macro-vascular complications of
diabetes[10],[11] Further, few successful models are available to guide
patient
behavior modification choices and lifestyle changes known to reduce
risk for development of diabetes or for successful management of the
disease once it is diagnosed Center funds are targeted at new, expanded,
or innovative approaches to address these gaps Funds issued through this
application process are not intended to support existing programs; however,
expansion of existing programs to address service gaps, to meet newly
identified needs, or to extend services to new populations at risk are
eligible for funding

Why the need for standardized measures?
Use of standardized measures allows tracking of progress toward goals and
comparisons of participants health behaviors and health status associated
with prevention and treatment programs targeting diabetes and pre-diabetes
Thus, in addition to program process and outcome measures you deem
appropriate to reflect impact of your program, inclusion of appropriate
BRFSS, YRBSS, and/or ADA process and outcome measures is required
Standard measures for physical activity, dietary choices and behaviors,
BMI, and ADA treatment targets are especially important

The Behavioral Risk Factor Surveillance System BRFSS, established in 1984
by the
Centers for Disease Control and Prevention CDC, is a state-based
system of health surveys that collects standardized information on health
risk behaviors, preventive health practices, and health care access
primarily related to chronic disease and injury Data are collected monthly
in all 50 states, the District of Columbia, Puerto Rico, the US Virgin
Islands, and Guam BRFSS data are used to identify emerging health
problems, establish and track health objectives, and develop and evaluate
public health policies and programs Many states also use BRFSS data to
support health-related legislative efforts This and more information about
the BRFSS is available at http://wwwcdcgov/brfss/abouthtm
The Youth Risk Behavior Surveillance System YRBSS was developed in 1990
to monitor priority health risk behaviors that contribute markedly to
leading causes of death, disability, and social problems among youth and
adults in the United States These behaviors, often established during
childhood and early adolescence, include tobacco use, unhealthy dietary
behaviors, inadequate physical activity, etc YRBSS surveys are conducted
by CDC and target students in grades 9-12 in public and private schools
as
well as other at risk youth sub-groups Data are used to identify emerging
health problems, establish and track health objectives, compare data among
sub-populations of youth, and develop and evaluate public health policies
and programs This and more information about the YRBSS is available at
http://wwwcdcgov/HealthyYouth/yrbs/overviewhtm
The American Diabetes Association ADA has established clinical guidelines
for process and outcome measures for patients with diabetes designed to
prevent diabetes-related complications These include process and
periodicity testing and examination recommendations and corresponding
biologic targets for hemoglobin A1c, blood pressure, lipids, urine
microalbumin, dilated eye exams, foot exams, and body mass index These
recommendations are available at Diabetes Care, January 2008, Volume 31,
Supplement 1, S1-S110
http://carediabetesjournalsorg/content/vol31/Supplement_1/

Healthy People 2010 also incorporates many of the objectives that are
measured above in BRFSS, YRBSS, and by the ADA As well as listing the
national baseline for each objective measure, Health People 2010 objectives
give a target measure to aim for by the year 2010 Programs are
required
to incorporate the Healthy People 2010 objectives More information is
available at http://wwwhealthypeoplegov/

II Eligible Applicants

Primary and specialty providers of health care services related to the
prevention and/or treatment of obesity, pre-diabetes and diabetes are
eligible to apply All community and faith-based organizations, regional
and county health departments, clinics and other for-profit or not-for-
profit health-related providers are eligible to apply In order to be
eligible for a grant, an entity shall demonstrate evidence of financial
stability, utilize evidence-based practices, and show measurable results in
its programs

Availability of Funding

The Center will make program implementation funds available to eligible
applicants that have identified a sound program concept targeting
prevention and/or improved diabetes treatment and patient outcomes While
the sizes and terms of program implementation grants will vary by
circumstance and need, they will not typically exceed 250,000 for
implementation grants over a period of twelve months Because the nature
and scope of the proposed programs will vary from application to
application, it is
anticipated that the size and duration of each award
will also vary The total amount awarded and the number of awards will
depend on the numbers, quality, and scope of the applications received The
Center reserves the right to issue subsequent requests for applications for
Project Diabetes Program Implementation funds in the future

IV Funding Priorities

Priority will be given to proposals that:

a Target communities or populations with a documented high
prevalence of diabetes or diabetes risk factors
b Target groups of low socioecomnomic status
c Focus on diabetes and obesity prevention among Tennessee youth
less than 21 years of age who are at high risk of developing
diabetes eg overweight or obese youth and or youth with a
strong family history of Type 2 diabetes
d Test cost-effective, sustainable strategies for achieving
control of hyperglycemia, hypertension, and dyslipidemia known
precursors of diabetes and its complications
e Test cost-effective, sustainable strategies for producing
sustainable lifestyle modifications known to reverse or prevent

overweight, obesity, pre-diabetes, or Type 2 diabetes in high
risk populations eg improved physical activity and fitness
and/or improved nutrition
f Are novel in design but structured with regard to current
evidence or models demonstrated to prevent or reverse overweight
or obesity and Type 2 diabetes, to improve care of patients with
Type 2 diabetes, and/or to prevent or postpone development of
known obesity- or diabetes-related complications
g Engage a representative sample of the designated population
without regard to insurance status
h Demonstrate clear evidence of strong community partnerships and
sharing of resources

V Appropriate Use of Funds

Successful Project Diabetes Program Implementation Grant funding recipients
are expected to use grant funds to address and meet identified local
community needs in the area of prevention and/or treatment of overweight,
obesity, pre-diabetes, and/or diabetes For example, funds may be used to
test interventions to: 1 promote lifestyle or behavior changes to reduce
risk of diabetes eg increasing physical activity;
improving nutrition
and wellness; 2 improve health care delivery to patients with diabetes
or those at risk for developing diabetes; and/or 3 improve self-care or
patient activation or self-efficacy for self-care, etc

Indicators of cost-effectiveness and sustainability of proposed
interventions and the ability to disseminate findings to other health care
systems, schools, workplaces, etc are critical program elements

Project Diabetes funds may not be used to provide religious instruction,
conduct worship services, or engage in any form of proselytization; to
assist, promote, or deter union organizing; finance, directly or
indirectly, any activity designed to influence the outcome of an election
to any public office; or to impair existing contracts for services or
collective bargaining agreements

VI Guidelines for Project Diabetes Implementation Application Submission

TIMELINE
Application posted: September 22, 2008
Pre-Proposal Conference: September 26, 2008 at 9:00 am CST
Notice of Intent to Propose: September 29, 2008 by 2:00 pm CST
Application Deadline: October 22, 2008 by 2:00 pm CST

Notice of Intent to Propose
Each potential proposer should
submit a Notice of Intent to Propose to the
RFP Coordinator by September 29, 2008 by 2pm CST The notice may be
emailed or mailed in hard copy and should include:
Proposers name
Name and title of a contact person
Address, telephone number, email and facsimile number of the contact
person

A Pre-Proposal Conference will be held on September 26, 2008, at 9:00am
CST The purpose of the conference is to discuss the RFP scope of
services While questions will be entertained, the response to any
question at the Pre-Proposal Conference shall be considered tentative and
non-binding with regard to this RFP

Pre-Proposal Conference attendance is not mandatory, and each potential
Proposer may be limited to a maximum number of attendees depending upon
overall attendance and space limitations The conference will be held at:

Cordell Hull Building
5th Ave North
Nashville, TN 37247
5th Floor WIC Conference Room
Telephone access if unable to attend in-person
615 253-6917 local
800 404-8189 toll-free

Project Diabetes
Program Implementation applications should be assembled
and submitted in the order presented below The application, prepared in
accordance with the criteria and forms contained in these guidelines, must
be submitted to the Tennessee Center for Diabetes Prevention and Health
Improvement no later than 2:00 PM CT October 22, 2008

All applications may be mailed or hand-delivered An additional electronic
copy must be submitted Faxed or emailed applications, without the
accompanying mailed /hand delivered application will not be accepted
Application packets must contain the following:

FULL APPLICATION:

A Cover Sheet: form attached Appendix B

B Table of Contents: Submit a table of contents for the application,
including the abstract and all attachments Table of Contents will not
count towards page limit

C Project Abstract not to exceed 200 words: Provide a brief summary of
the application Prepare the abstract so it is clear, accurate, concise,
and without reference to other parts of the application The abstract
should include a brief description of the proposed grant project
including the needs to be addressed, the population groups to be served,
the
goals of the project, and a description of the services to be
provided

D Program Narrative not to exceed 15 typed, double-spaced pages: This
section provides a comprehensive description of all aspects of the
proposed program The narrative should be succinct and well-organized so
that reviewers can understand the proposed project The Program Narrative
should include:

1 Introduction: This section should briefly describe the purpose of
the project, as well as applicant organization and any collaborating
agencies

2 Background and Need: The applicant should demonstrate the need for
funding to support project activities Provide information about your
community, including statistical and census data as well as information
about the burden of diabetes in your county/region/area to demonstrate
need by the target population You should also include information
regarding how you have included the input of the target population in
determining the need for the project

Assessing Project Need and Target Populations
Questions to Address in Grant:
Is the target populations clearly defined?
Is
the target populations a funding priority?
Do diabetes related data for the target populations
document needs compared to other populations and/or statewide
averages?
Do the data document significant health disparities in the
target populations?

3 Program Goals and Objectives: Provide a concise description of the
proposed program The Center requires that the program address one or
more of the Healthy People 2010 goals listed below:

Healthy People 2010:
1 Diabetes Healthy People 2010; Chapter 5 Through
prevention programs, reduce the disease and economic burden
of diabetes, and improve the quality of life for all
persons who have or are at risk for diabetes
2 Nutrition and Overweight Healthy People 2010; Chapter 19
Promote health and reduce chronic disease associated with
diet and weight
3 Physical Activity and Fitness Healthy People 2010, Chapter
22 Improve health, fitness, and quality of life through
daily physical
activity

Objectives for each of the three listed Health People 2010 goals
are available at http://wwwhealthypeoplegov/

Programs are required to incorporate one or more of the
objectives listed under the appropriate Healthy People 2010
goal These objectives are measureable and must be the central
core of the program evaluation Standardized ways of measuring
the Healthy People 2010 objectives are discussed further in this
document within Section 6, Evaluation

Please note that the objectives given by the Healthy People 2010
are an excellent resource but must be tailored to your given
program with additional details with regards to the programs
target population and time frame Appendix C is a short guide
to writing strong project objectives

Remember to clearly state both the Healthy People 2010 goals and the
measureable objectives for your project Goals should be stated as
overarching statements of what you choose to accomplish, and
objectives should be specific, measureable statements of what your

project will achieve see Appendix C

Program Goals and Objectives
Questions to Address in Grant:
Is the program goals clearly defined?
Is the program objectives clearly defined?
Does the program objectives have a clearly defined outcome
measures?

4 Work Plan/Methodology: Use this section to describe proposed
methods you will use to meet each of the project objectives you stated
in Section 3 The methods of achieving your objectives should be in
line with evidence-based, cost-effective methods A good resource is
The Guide to Community Preventative Services: What Works to Promote
Health? available at http://wwwthecommunityguideorg/
Clearly state the methodology of the program and the evidence to
support the method of the interventions

The method section should include a clear time-line that identifies
each key activity, identifies responsible staff designated to
successfully carry out each activity, and includes the anticipated
completion date for each activity Examples of key activities include
recruitment of participants
that are representative of the target
population and adequate in number or obtaining IRB approval for your
program by a specified date and time In addition to goals and work
steps, include letters of support from key partners with the completed
application for program funding submission Letters of support must
outline specific contributions the partners intend to make to this
project and must be signed by an individual at the partnering agency
who has the power to bind the partner

Work Plan/Methodology
Questions to Address in Grant:
Are the objectives and strategies in the work plan clearly
described, appropriate, and realistic?
Are the strategies in the work plan evidenced-based, best
practices?
Are strategies described to engage needed partners to
implement the proposed activities? Are strategies described
to engage and recruit the target populations?
Does the work plan include frequency of activities that are
appropriate and realistic?
Does the work plan include realistic time
frames and
appropriately trained project staff and other trained
volunteers/stakeholders to carry out the strategies?
Does the proposal clearly describe the broad-based
collaborative effort needed to effectively implement the
grant?
Are the partner contributions clearly described, appropriate,
and realistic?
Has the applicant identified current diabetes-related
prevention and treatment initiatives in the community with
the priority populations? Is it clear how this proposal will
enhance existing efforts and how the applicant has or will
actively collaborate with them?
Are letters of support from the necessary collaborative
partners included? Does each letter outline specific
partners contributions? Does the letter include names,
organization or affiliation, and contact information?

5 Staffing Plan: In this section, provide a staffing plan with
justification for each staff position Include education and
experience qualifications, and
rationale for the amount of time being
requested for each position Include both currently employed staff
and staff who will be hired as part of the project The staffing plan
must be consistent with the expected workload, goals and objectives
for the project Position descriptions that include the roles,
responsibilities and qualifications of proposed project staff, as well
as biographical sketches for any key personnel who are currently
employed must be included as an attachment to the application

Staffing Plan
Questions to Address in Grant:
Are the program staff roles and responsibilities clearly
defined?
Are the program staff roles and responsibilities consistent
with the expected workload, goals, and objectives for the
project?
Are the necessary position descriptions and biographical
sketches included?

6 Evaluation: Provide a detailed plan for the evaluation and
documentation of your project The evaluation plan must include the
method of measuring and collecting your objective measurements for
the
population targeted/participating in your program The evaluation and
documentation plan must also include sufficient detail to allow for
replication of your project or its components by other agencies In
this section, you should also list potential challenges or barriers to
the completion of your project and provide possible approaches you
will use to overcome them

Note: In addition to process and outcome measures determined by the
applicant, programs targeting behavior change must include designated
nutrition and/or physical activity indicators from standardized
Behavioral Risk Factor Surveillance System BRFSS items available at
http://wwwcdcgov/brfss/questionnaires/pdf-ques/2006brfsspdf for
adults or from Youth Risk Behavior Surveillance System YRBSS items
available for middle school aged children at
http://wwwcdcgov/HealthyYouth/yrbs/pdf/questionnaire/2007MiddleSchool
pdf or for high school aged children at
http://wwwcdcgov/HealthyYouth/yrbs/pdf/questionnaire/2007HighSchoolp
df Carefully note and include additional diabetes related
measures in BRFSS Module 4 as
appropriate

Projects targeting diabetes or pre-diabetes treatment changes must
include appropriate therapeutic American Diabetes Association ADA
clinical guidelines for process and patient outcome measures These
may include some or all of the following: hemoglobin A1c, blood
pressure, lipids, urine microalbumin, dilated eye exams, foot exams,
and body mass index

All projects must submit success stories from project participants A
minimum of two 2 success stories are required and should include a
picture and a brief description of the participants success and the
participants county of residence Participants must agree by signing
a release form Original release form shall be submitted to the state
with the success story submission

Evaluation
Questions to Address in Grant:
Are the appropriate BRFSS, YRBSS, and/or ADA standard
measures clearly defined? Are additional performance and
outcome measures specific to the proposed project clearly
defined?
Is the methodology for collecting the standardized measures

clearly described and in sufficient detail to allow other
agencies to replicate the process?
Are potential challenges or barriers to the completion of the
project listed? Are possible approaches to overcome the
challenges or barriers described?

7 Project Impact: Describe the anticipated impact of your project in
your community Also provide a brief description of how the project
will be sustained beyond the 2009-2010 year grant period

8 Organizational Information: Provide a brief history of your
organization Include year founded, annual budget, staffing, services
provided and current programs focused on prevention and/or treatment
of diabetes Describe how your agency assesses quality of services
delivered and any continuous improvement efforts Identify key staff
responsible for the administration of the proposed program and their
background and experience, including the primary contact
person/administrator for the program Clearly describe your agencys
capacity to manage Project Diabetes grant-related expenditures and
monitor matching
funds, including accounting and auditing systems
Identify areas where the proposed program could strengthen your
agencys capacity, and include a plan for program staff orientation or
refresher training to be pursued during the year, as appropriate
Enclose a copy of your agencys most recent audit

Organization Information
Questions to Address in Grant:
Does the applicant have the capacity administrative,
facilities, etc to implement the proposed activities? Is
there institutional support?
Does the applicant have experience in diabetes prevention and
treatment, public health approaches to health issues,
community organizing, public education, and other grant
related areas?
Does the applicant assess quality of services delivered and
have continuous quality improvement efforts in place?
Does the applicant have experience in working with other
community or statewide partners on these and/or related
issues?
Is there adequate and appropriate staffing to accomplish

project activities, including administering and monitoring
grant funds, data collection and analysis, and reporting of
data to the Center?

E Budget and Budget Narrative:

1 Budget
Complete and submit the budget forms Form A and Form B from the
Excel spreadsheet entitled Budget Format Appendix D Form A and
Form B are samples from the Excel spreadsheet Appendix D, Form A
corresponds to the Excel panel budget; Appendix D, Form B
corresponds to the Excel panel detail The application budget must
be submitted using the Excel spreadsheet format

2 Budget Narrative
Complete and attach a detailed narrative that is organized in the same
order as the budget form, clearly identifies rationale for the
requested funds and grantee share, and supports the proposed program
described in the application narrative Use the format provided in
Appendix D, Form A and Form B, as the guide for how to organize the
budget narrative Describe how resources will be obtained to support
the program design Funding for indirect costs should not typically
exceed 15 and must
be supported by an approved cost allocation plan

3 Match Requirement
A minimum 33 dollar for dollar, cash or in-kind match is required;
however, special consideration will be given to those programs able to
secure matching funds in excess of 33 Match may be other federal
funds Cash or in-kind funds may include facilities, equipment, or
services Shares may come from private, state, or federal sources
In the case of federal or private sources, the funds of another agency
may only be used as match if the other agency permits such use The
match amount provided by the Applicant is in addition to the grant
contract amount awarded by the Center

F Assurances:
Complete the form following the instructions in Appendix E This form
must be signed The original copy must have an original signature

G General Submission Instructions:
The application should be on 8 x 11 paper with 1 margins and no less
than an 11 pt Times New Roman Font, double-spaced font Each section
should be clearly identified and include all required components and
forms Proposals should be stapled or binder clipped - - no notebooks
or
spiral rings Charts/graphs/tables are acceptable and not required to be
double-spaced Charts/graphs/tables are included in the 15 page limit

The following should be included as attachments to the proposal and does
not count as part of the page limit:
Job descriptions for key personnel keep each to one page
Biographical sketches/Curriculum Vitae for currently employed key
personnel keep each to one page
Project organizational chart include significant collaborators
Letters of commitment and support from project partners must be dated
and provide specific information about how the partner will support
the activities of the project

An original, 4 copies, and an electronic copy of the complete application
must be received no later than 2:00 PM CDT on the designated submission
date at the address listed on page one 1 of this document All
applications may be mailed or hand-delivered An additional electronic
copy must be emailed Incomplete or late applications will not be
accepted nor considered Faxed submissions will not be accepted

Please submit applications to the Application Coordinator listed on
page
one 1 of this application

VII Application Review Process

All completed application packages received by the Tennessee Center for
Diabetes Prevention and Health Improvement on or before the submission due
date at 2:00 PM CT will be reviewed by the Center for technical merit based
on criteria as cited in these guidelines Applications may also be
reviewed by content matter experts and staff of the Department of Health
for technical merit based on criteria as cited in these guidelines Upon
completion of this review, the Center will issue funding award notices to
successful applicants

Funding awards are not considered final until a fully executed state
contract listing scope of services to be provided is sent to the grantee by
the Tennessee Center for Diabetes Prevention and Health Improvement

Questions regarding the Project Diabetes Application or technical
assistance should be addressed to the Application Coordinator listed on
page one 1 of this Application

APPENDICES

Forms and Instructions

Appendix A

State of Tennessee

Center for Diabetes Prevention and Health Improvement
Project Diabetes Program Implementation Grant

Quarterly Progress Report Guidelines

Follow the guidelines written below and submit your report to the
individual listed on page one 1 of this document by hand delivery or
mail The title page should include:

Name of Your Organization

Title: Project Diabetes Program Implementation Grant

Date of report

Title of your project/program

Grant start and end dates

Dates covered in the report

Name, position, and contact information of person preparing
report

Organize your report as cited below, and address each question in your
text Support your answers to questions with quantitative data where
available and appropriate Provide other supportive evidence as needed
to answer the question Include appendices as necessary

I Program Objectives Table

Complete the Program Objectives Table A sample table and blank
template are provided

Chart text should be succinct and to the point You will
have an
opportunity to describe the main program activities in narrative form
under Section II below

Note: The remaining sections of the progress report require narrative
responses Please do not exceed a total of five double-spaced pages
for the following sections:

II Goals, Objectives and Activities

A If an objective or planned activity was not achieved, please
explain what happened and why
B Were the project objectives modified significantly during this
reporting period? If yes:
i Clearly state the new objective
ii Explain why and how the changes were made;
iii Explain how the new objective will be measured; and
iv How will changes affect the planned program activities
and/or outcomes?
C Give a detailed account of the main project activities listed in
the Program Objectives Table and any other accomplishments you
would like to share
D Are you on track to realize the goals of the project by the end of
the funding period? If not, please explain
E Describe any additional accomplishments
achieved beyond the
original or revised objectives
F List any preliminary findings or general observations in bulleted
form

III Challenges

A What challenges to success of the project are you encountering? Are the
challenges primarily internal from within the organization or external?
B How did you, or will you, resolve the challenges?

IV Materials
A Have you produced any materials using grant funds? If yes, provide a
bibliography and copies of the materials

V Budget
A Did you make any significant changes to the budget during this reporting
period? If so, explain
B Did you miscalculate your needs in any particular line item? If so,
explain

VI Additional Comments
A Summarize general impressions about your program thus far

Appendix A

Quarterly Progress Report - Program Objectives Table SAMPLE

Center for Diabetes Prevention and Health Improvement
Project Diabetes Program Implementation Grant Objectives Table

Please list your approved program objectives For each program objective,
describe strategies and activities for
achieving these objectives and
indicate your progress for each objective

SAMPLE

Appendix B
Project Diabetes Program Implementation Application
Tennessee Center for Diabetes Prevention and Health Improvement

APPLICATION COVER PAGE

Date of Submission:______________________

Legal Name of Applicant
Organization:_____________________________________________________

Federal
ID_________________________________________________________________________
__

Primary Contact Person:_______________________________
Title:___________________________

Telephone:_____________________________________
Email:_______________________________

Secondary Contact Person:_____________________________
Title:____________________________

Telephone:_____________________________________
Email:________________________________

Name of Person
Authorized to Sign
Contract:________________________________________________

Title:_____________________________________
Email:______________________________________

Telephone
:__________________________________________________________________________
_

Organization
Address:___________________________________________________________________

City:__________________________________________
Zip:___________________________________

Fax :_________________

What is the focus of your Program? Prevention Treatment

Geographic Location: Urban Suburban Rural

List Counties Served:
_______________________________________________________

Target Population at
Risk:____________________________________________________

Target Population Age: Children less than age 12 Adolescents
Adults

Anticipated number of participants:_______________________________________

State funds requested:_______ Total Match Pledged: _________Total Program
Budget___________

The applicant certifies to the best of his/her knowledge and belief that
the data in this application has been duly authorized by the governing body
of the applicant and the applicant will
comply with the certifications and
assurances required of applicants if this assistance is approved

Name:_________________________________
Signature:______________________________

Title:__________________________________
Date:___________________________________
Appendix C

A GUIDE TO WRITING PROJECT OBJECTIVES

Goals vs Objectives
Understanding the differences between goals and objectives is important to
planning a strong project that can be implemented and evaluated Goals are
broad, brief statements of intent that provide a general focus for
planning They are non-specific, non-measurable, and do not have an
associated time frame An example of a typical program goal is:

To improve the health of persons living with diabetes in our region

Objectives
Objectives are meant to be realistic statements that help to target the
program or project They help to provide a basis for the action plan as
well as for the project evaluation Objectives can help you focus your
program by answering the following questions:

WHO is going to do WHAT, WHEN, WHY what does it demonstrate, and TO WHAT
EXTENT OR STANDARD?

A simple acronym you can use to develop and
state your objective is SMART
SMART objectives have the following attributes:

Specific
What are we going to do, with or for whom?
The outcome should be clearly defined, and stated in numbers, percentages,
frequency, reach, scientific outcome, etc If the objective is not
specific, reviewers may not understand exactly what you plan to accomplish

Measurable
How are we going to measure what we do?
This means that the objective can be measured and the measurement source is
identified If the objective cannot be measured, you will be unable to
state the success of your project upon evaluation

Achievable
Can we get it done in the proposed time frame and with this amount of
money?
The objective must be achievable and realistic When considering this
aspect, be sure to think about anything that may influence your ability to
accomplish the objective, such as the time frame of the project, resources
allocated, political climate, needs of collaborating partners, etc You
should also be realistic when setting the number of objectives to be
accomplished within your project

Relevant
Will the accomplishment of this objective lead to the desired results?
This means that the outcome or results
of the objective should directly
support the goals of your individual program project and of Tennessees
Project Diabetes

Time-bound
When will we accomplish this objective?
This means stating clearly when the objective will be achieved Specific
information about when you will achieve objectives will help you develop a
more effective action plan for your program

Example
Here is an example of a poorly written project objective, and how it could
be made into a SMART objective:

The SMART objective in column 2 is:
Specific: A screening test for diabetes will be provided to persons under
age 21
Measurable: We will count the total number of persons under age 21 who
receive diabetes screening and compare it to a baseline for evaluation
Achievable: Given our
resources and program plan, we can realistically
expect a 5 increase within the given time frame
Relevant: The objective supports the overarching goals of Project Diabetes
Time-bound: The objective will be accomplished by December 2008

Remember that each objective should answer the questions: WHO, WHAT, WHERE,
WHEN, WHY, and TO WHAT EXTENT OR STANDARD For project success, make your
objectives SMART

Budget Forms Form A and Form B

Applicants must attach a detailed Budget Narrative describing the rational
for the expenditures listed in both Form A and B of Appendix D; Form A and
Form B are shown on the next two pages For line items that require a
detail to be attached connoted by detail attached on the line item of
the budget, please provide the detail Form B for the grant contract
amount your agency is requesting separately from the detail for the grantee
match, if any Please use the format on the following pages as a guide in
organizing the budget narrative

Grant Budget Line-Item Definitions - are available at
http://wwwtennesseegov/finance/act/policy3pdf

|Appendix D Budget Form A |SAMPLE Use
Excel |GRANT BUDGET |GRANTEE | |PROGRAM AREA: |Refer to Department |Requirements and |Grant Monies, Appendix |line-item in the model budget format |at: http://wwwtennesseegov |THE FOLLOWING IS |Start date:________________ |POLICY 03 Object|EXPENSE |Line-item |CATEGORY |Reference |detail | |as applicable | | | | |1 |Salaries | | |2 |Benefits Taxes | | |____ |4, 15 |Professional | |/ Grant | |Awards |5 |Supplies |6 |Telephone |7 |Postage | |Shipping |8 |Occupancy |9 |Equipment Rental | |
| |Maintenance |10 |Printing | |Publications |11, 12 |Travel / | |Conferences | |Meetings | |must include | | |500 for | |statewide | |meetings |13 |Interest | | |14 |Insurance |16 |Specific |
| |Individuals |17 |Depreciation | | |18 |Other | |Non-Personnel |20 |Capital | | |22 |Indirect Cost | | |[PERCENT] | |24 |In-Kind Expense | |25 |GRAND TOTAL |
Spreadsheet Titled Budget Format/Budget |
|
|
|Project Diabetes: Program Implementation Grant |
of Finance and Administration Policy 03, Uniform Reporting |
Cost Allocation Plans for Sub recipients of Federal and State |
A for further definition of each expense object |
Policy 03 can be found on the Internet |
/finance/act/policy3pdf |
APPLICABLE TO EXPENSE INCURRED IN THE PERIOD: |
End date:__________________ |
OBJECT LINE-ITEM |GRANT |GRANTEE |TOTAL |
|CONTRACT |MATCH |PROJECT |
schedules attached | | min 33| |
| |of |
|
| |total | |
| |project | |
|detail |000 |000 |000 |
|attached | | | |
|000 |000 |000 |
| | | | |
Fees|detail |000 |000 |000 |
|attached | | | |
| | | | |
| |000 |000 |000 |
| |000 |000 |000 |
| |000 |000 |000 |
| | | | |
| |000 |000 |000 |
|000 |000 |000 |
| | | | | |
| | | | |
| |000 |000 |000 |
| | | | |
|detail |000 |000 |000 |
|attached | | | |
| | | | |
| | | |
| | | | |
| | | | |
| | | | |
|detail |000 |000 |000 |
|attached | | | |
| |000 |000 |000 |
|detail |000 |000 |000 |
|Assistance to |attached | | | |
| | | | |
|detail |000 |000 |000 |
|attached | | | |
|detail |000 |000 |000 |
|attached | | | |
Purchase |detail |000 |000 |000 |
|attached | | | |
|000 |000 |000 |
| | | |
|000 |000 |000 |
| | |000 |000 |

APPENDIX D Budget Form B
|SAMPLE Use Excel Spreadsheet Titled Budget Format/Detail |
|GRANT BUDGET LINE-ITEM DETAIL INFORMATION |

Assurance is hereby provided that:
1 This program will be administered in accordance with all applicable
statutes, regulations, program plans and applications:
a The laws of the State of Tennessee;
b Title VI of the federal Civil Rights Act of 1964;
c The Equal Employment Opportunity Act and the regulations issued there
under by the federal government;
d The Americans with Disabilities Act of 1990 and the regulations issued
there under by the federal government;
e The condition that the submitted proposal was independently arrived at,
without collusion, under penalty of perjury; and,
f The condition that no amount shall be paid directly or indirectly to an
employee or official of the State of Tennessee as wages, compensation, or
gifts in exchange for acting as an officer, agent, employee,
subcontractor, or
consultant to the Agency in connection with any grant
resulting from this application
2 Each agency receiving funds under any grant resulting from this
application shall use these funds only to supplement, and not to supplant
state and local funds that, in the absence of such funds would otherwise
be spent for activities under this section
3 The grantee will file financial reports and claims for reimbursement in
accordance with procedures prescribed by the Tennessee Center for
Diabetes Prevention and Health Promotion
4 Grantees awarded grants resulting from this application process will
evaluate its program periodically to assess its progress toward achieving
its goals and objectives and use its evaluation results to refine,
improve and strengthen its program and to refine its goals and objectives
as appropriate
5 If applicable, the program will take place in a safe and easily
accessible facility

I, THE UNDERSIGNED, CERTIFY that the information contained in the
application is complete and accurate to the best of my knowledge; that the
necessary assurances of compliance with applicable state/federal statutes,
rules and regulations
will be met; and, that the indicated agency
designated in this application is authorized to administer this grant

I FURTHER CERTIFY that the assurances listed above have been satisfied and
that all facts, figures and representation in this application are correct
to the best of my knowledge

____________________________________________________________________________
____
Signature of Applicant Agency Administrator Date
Signed Month/Day/Year

Project Diabetes Program Implementation Application
Tennessee Center for Diabetes Prevention and Health Improvement

APPLICATION PACKAGE CHECKLIST

To be completed by Application Coordinator

Project Diabetes Program Implementation Application
Tennessee Center for Diabetes Prevention and Health Improvement

SUMMARY OF GRANT TIMELINE

Notice of Intent to Propose
Each potential proposer should submit a Notice of Intent to Propose to the
RFP Coordinator by September 29, 2008 by 2pm CST The notice may be
emailed or mailed in hard copy and should include:
Proposers name
Name and title of a contact person
Address, telephone number, email and facsimile number of the contact
person

Cordell Hull Building
5th Ave North
Nashville, TN 37247
5th Floor WIC Conference Room
Telephone access if unable to attend in-person
615 253-6917 local
800 404-8189 toll-free

The application, prepared in accordance with the criteria and forms
contained in these guidelines, must be submitted to the Tennessee Center
for Diabetes Prevention and Health Improvement no later than 2:00 PM CT
October 22, 2008

———————–
[1] Tennessee Department of Health: Tennessee Health Status Report, 2002;
p 74-75 Accessed January 27, 2006
http://hitstatetnus/Hsr2002_coveraspx
[2] National Diabetes Education Program, http://wwwndepnihgov/ Accessed
January 27, 2006
[3] Tennessee Department of Health, Diabetes Fact Sheet,
http://wwwtennesseegov/health/itsabouttime/diabetes_fact_sheetpdf
[4] Tennessee Department
of Health, Tennessees Behavioral Risk Factor
Survey 2004, p 4
[5] Ibid
[6] National Diabetes Education Program, http://wwwndepnihgov/ Accessed
January 27, 2006, p43
[7] Kids Count: State of the Child in Tennessee, 2004
http://wwwstatetnus/tccy/KCSOC4-2pdf
[8] American Diabetes Association, Direct and Indirect Costs of Diabetes
in the United States- 2002 data, http://wwwdiabetesorg/diabetes-
statistics/cost-of-diabetes-in-usjsp
[9] McGlynn E, Asch SM, Adams J, et al The quality of health care
delivered to adults in the United States N Engl J Med 2003;348,2635-45
[10] Saydeh SH, Fradkin J, Cowie CC Poor control of risk factors for
vascular disease among adults with previously diagnosed diabetes JAMA
2004;291:335-3424
[11] McFarlene SI, Jacober SJ, Winer N, et al Control of cardiovascular
risk factors in patients with diabetes and hypertension at urban academic
medical centers Diabetes Care 2002;25:718-723

———————–
GENERAL ASSURANCES Appendix E

CERTIFICATION/SIGNATURE

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