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zjj2d3QBZLFjfXH4HX6Dns83nCLJi7XVrkpFZNzpsmTVgnBfk5qFH8DvDDM3abzAPtFDQbSae

iHEART Project Proposal

The iHEART Collaborative leverages IU Health's clinical care expertise and medical infrastructure through partnerships with community-based organizations to extend cardiovascular care resources to residents of high CVD-risk communities. iHEART seeks to reach residents through neighborhood and clinic access points.

Applicants are encouraged to apply for grants up to $7000 to support community-driven approaches to addressing cardiovascular disease.

Complete the following questions to serve as your project submission for consideration of the iHeart Near Southeast Side Steering Committee. You will be able to return to the survey to complete it later if you cannot do it all at one time. You will be able to download a copy of the completed survey for your records at the end.

Should your project be approved by the steering committee, please be aware that secondary review will required by IU's finance and procurement teams. A member of the finance team may be in contact with you if IU's policies require additional steps or documentation (such as budget justifications, waivers, etc.) prior to issuance of an award. See the approval process here.

Please reach out to Carolyn Voigt at cevoigt@iu.edu if you have any trouble with the system or have questions.

If you would like to preview all the possible questions in the proposal, open the attachment shown below. (Please note that not all questions will apply to every proposal, so you may not be asked all of these.)

Attachment:iHEARTProjectProposal_form.pdf

Project name:

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In which iHEART target area for the Near Southeast Side will this project occur?

46203

46201

46225

46107

46206

Which iHEART focus area(s) does this project address?

Cardiovascular health (blood pressure, stroke, heart disease)

Physical activity

Healthy food access

Health equity (access to primary care, social resources)

Diabetes

Nutrition

Other chronic disease

What are the project's GOALS - what are you trying to accomplish? (Be sure the goals address the iHEART focus area(s) you selected.)

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How do you plan on measuring the success of your project? (ex: pre/post surveys, # of recipients receiving services, customer feedback, etc)

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Describe the project including:
- WHAT will be done as part of the project, and how often?
- WHERE this will be done?
- WHO will be participating, and how many people are expected each time?

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How will you recruit participants?

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When would the project start?

M-D-Y

How long would it last?

Approximately how many residents will benefit from this project in total?

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What type of support are you seeking from the iHEART team and/or Connections IN Health?

Partnering and financial support requested

Partnering requested, but no financial support

Other

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Tell us more about the partnering or other (non-financial) support you are seeking.

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What do you want to do with funds from iHEART?

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What is the total amount of funding you are requesting for the project from iHEART?

Please upload a document that shows how you arrived at your total budget. Explain the costs included by type. See example below.

The table below is an EXAMPLE BUDGET FORMAT just to demonstrate what we're seeking.

Example Budget Item	Costs
Class leader ($15/hr x 8 hours/week x 12 weeks)	$ 1,440
Class supplies for 50 participants costing $10 each	$ 500
(List all projected costs by type in new rows)	$ --
Total:	$ sum of all costs

Upload file

Do you plan to keep this project or work going after the iHEART collaboration period ends?

Yes

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Briefly, what are those longer-term plans?

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What date is this proposal form submitted?

M-D-Y

Name:

Email address:

Phone Number:

Are you a resident of the community where the project will occur?

Yes

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How were you connected to the iHEART Steering Committee?

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Do you represent an organization?

Yes

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What is the name of the organization?

Is the organization located in the community where the project will occur?

Yes

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Are there other community residents/organizations involved in leading this project?

Yes

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Who are these other organizations/residents?

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.