Section 691.500  Application Procedures

The Department will provide written application instructions and forms to potential applicants. 

a)         Applications may be submitted to the Department at the following address:

African-American Response Act Grant

Illinois Department of Public Health

HIV/AIDS Program

525 W. Jefferson St., 1^st Floor

Springfield IL  62761-0001

b)         All applications shall be submitted on the form prescribed by the Department and shall include, at minimum, the following:

1)         Name of the primary contact for the applicant, address, e-mail, and telephone, fax and teletypewriter (TTY) numbers, if available;

2)         Name of the African-American community-based organization for which the application is being submitted, and the address, telephone, fax and teletypewriter (TTY) numbers, if available;

3)         Federal Tax Identification Number;

4)         Resume or curriculum vitae of the principal investigator;

5)         One-page non-technical abstract that describes the scope of the project for which funding is being sought;

6)         List of members of the Board of Directors, position, term, and race;

7)         Certificate of Good Standing from the Office of the Secretary of State;

8)         Description and location of high-risk community to be served;

9)         Work plan for the funding period, including a list of objectives as described in Section 691.400, and an approximate timetable for completion;

10)         Detailed budget for the funding period, documenting sufficient resources to complete the objectives addressed in the work plan.  The budget shall be by line item category and shall provide sufficient detail to justify the use of grant funds to support project activities.  The applicant shall indicate the amount of the total funding requested from the Department and sources of other funding available to support the project objectives, if applicable.  Grant recipients shall limit administrative costs included in the project budget to no more than ten percent of total funds requested; 

11)         The signature of the organization official authorized to certify the application; and

12)         Description of evaluation methods to measure progress in achieving objectives and a plan for monitoring the overall project.