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–
2 –
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V.
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Conditions of Award if Funded:
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Signed:
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Dated:
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MCH
Grant Proposal Review Form
Division
of Family Health
Continuation
Application
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Grant Title:
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Proposal Submitted by:
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(Agency
Name)
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Amount of Assistance Requested
in this Application:
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Current Fiscal Year Funding
Level:
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Ratings: In each of the following categories please rate the proposal
according to the information provided in the written submission in the
performance report with five being high and one being low; circle the desired
rating.
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Category
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Rating
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I.
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Previous performance based on
materials provided by program administrator (site review and summary of
previous statistics and fiscal data).
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1
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2
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3
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4
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5
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II.
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Merit of this proposal in
addressing the purpose and criteria for the grant (Scope and standard of
services described in the Rules and Regulations).
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1
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2
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3
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4
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5
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III.
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Reevaluation of need for
services within the area of service (refer to Rules and Regulations).
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1
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2
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3
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4
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5
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General Comments:
|
I.
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Are there particular strengths
or weaknesses in the proposal?
Please elaborate:
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II.
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Does this proposed budget need
revision or further explanations?
Please elaborate:
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Summary:
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I.
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Overall rank of of
continuation grants in this category reviewed by this reviewer.
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II.
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Overall score for this
continuation application
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III.
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Stipulations (if any):
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IV.
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Recommended grant award of
$ .
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Signed:
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Date:
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