**U.S. Department of Health and Human Services**

**Health Resources and Services Administration**

Bureau of Health Professions

Division of Health Careers Diversity & Development (DHCDD)

***CENTERS OF EXCELLENCE (COE)***

*HRSA 06-021*

**Catalog of Federal Domestic Assistance (CFDA) No. 93.157**

**PROGRAM GUIDANCE**

Fiscal Year 2006

**Application Due Date: JANUARY 26, 2006**

**Release Date: *November 4*, 2005**

**Date of Issuance*: November 4*, 2005**

Contact: Commander Jeanean D. Willis, DPM

Project Officer, Division of Health Careers Diversity and Development

Phone: (301) 443 - 4494

Fax: (301) 443-4943

Authority: Public Law (P.L.) 105-392, Title VII Section 736 of the
Public Health Service Act (Educational Assistance in the Health
Professions Regarding Individuals from Disadvantaged Backgrounds)

***Guidance Table of Contents***

[I. FUNDING OPPORTUNITY
DESCRIPTION...................................................
1](#__RefHeading___Toc83201452)

[***1.) Purpose*** 1](#Funding_purpose)

[***2.) Background*** 1](#Funding_purpose)

[II. AWARD INFORMATION 1](#__RefHeading___Toc83201459)

[***1.) Type of Award*** 1](#__RefHeading___Toc83201460)

[***2.) Summary of Funding*** 1](#__RefHeading___Toc83201461)

[IiI. ELIGIBILITY INFORMATION 1](#__RefHeading___Toc83201462)

[***1.) Eligible Applicants*** 1](#__RefHeading___Toc83201463)

[***2.) Cost Sharing/Matching*** 1](#__RefHeading___Toc83201464)

[***3.) Other*** 1](#__RefHeading___Toc83201465)

[IV. APPLICATION AND SUBMISSION INFORMATION
1](#__RefHeading___Toc83201467)

[***1.) Address to Request Application Package***
1](#__RefHeading___Toc83201468)

[**Application Materials** 1](#__RefHeading___Toc83201469)

[***2.) Content and Form of Application Submission***
1](#__RefHeading___Toc83201470)

[**Application Format Requirements** 7](#__RefHeading___Toc83201471)

[**Application Format** 8](#refheading___toc83201472)

[**i.) Application Face Page** 1](#__RefHeading___Toc83201473)

[**ii.) Application Table of Contents** 1](#__RefHeading___Toc83201474)

[**iii.) Application Checklist** 1](#__RefHeading___Toc83201475)

[**iv.) Budget** 1](#__RefHeading___Toc83201476)

**v.) Budget
Justification**............................................................................................11

[**vi.) Staffing Plan and Personnel Requirements**
1](#__RefHeading___Toc83201478)

[**vii.) Assurances** 1](#__RefHeading___Toc83201479)

[**viii.) Certifications and Other Requirements**
1](#__RefHeading___Toc83201481)

[**ix.) Project Abstract** 1](#__RefHeading___Toc83201483)

[**x.) Program Narrative** 13](#__RefHeading___Toc83201484)

**xi.)
Appendix**.....................................................................................................20

[***3.) Submission Dates and Times*** 20](#__RefHeading___Toc83201492)

[***4.) Intergovernmental Review*** 21](#__RefHeading___Toc83201494)

[***5.) Funding Restrictions*** 21](#__RefHeading___Toc83201495)

[***6.) Other Submission Requirements***
21](#__RefHeading___Toc83201496)

[V. APPLICATION REVIEW INFORMATION 21](#__RefHeading___Toc83201499)

[***1.) Review Criteria*** 21](#__RefHeading___Toc83201500)

[***2.) Review and Selection Process*** 28](#__RefHeading___Toc83201508)

[***3.) Anticipated Announcement and Award Dates***
28](#__RefHeading___Toc83201509)

[VI. AWARD ADMINISTRATION INFORMATION 28](#__RefHeading___Toc83201510)

[***1.) Award Notices*** 28](#__RefHeading___Toc83201511)

[***2.) Administrative and National Policy Requirements***
28](#__RefHeading___Toc83201512)

[***3.) Reporting*** 29](#refheading___toc83201514)

**4.) Performance
Review..............................................................................**.29

[VII. AGENCY CONTACTS 30](#__RefHeading___Toc83201515)

[VIII. OTHER INFORMATION 32](#__RefHeading___Toc83201516)

[IX. TIPS FOR WRITING A STRONG APPLICATION
37](#refheading___toc83201520)

[x. appendix 39](#__RefHeading___Toc83201521)

[***HRSA Training Grant Application Forms***
39](#__RefHeading___Toc83201522)

[***Form 6025-1*** 40](#form-6025-1)

[***Form 6025-2*** 43](#refheading___toc83201527)

[***Form 6025-3*** 44](#__RefHeading___Toc83201533)

[***COE Specific Suggested Templates*** 46](#__RefHeading___Toc83201536)

[]{#__RefHeading___Toc83201452 .anchor}[I. FUNDING OPPORTUNITY
DESCRIPTION]{.underline}

[]{#Funding_purpose .anchor}

Purpose

The "Health Professions Education Partnerships Act of 1998" P.L. 105-392
reauthorized and amended Title VII section 736(b) of the PHS Act
(Educational Assistance in the Health Professions Regarding Individuals
from Disadvantaged Backgrounds), generally known as the Centers of
Excellence program, hereafter referred to as COE. The amended
legislation provided changes that required institutions to provide
faculty development training, community service opportunities for
trainees, and health services to underserved communities.

The Centers of Excellence (COE) serve as innovative resource and
education centers to recruit, train, and retain Under Represented
Minority (URM) students and faculty at health professions schools. They
carry out activities to improve information resources, clinical
education, curricula and cultural competence as they relate to minority
health issues. The COEs also focus on facilitating faculty and student
research on health issues particularly affecting URM groups. The
ultimate goal of the program is to strengthen the national capacity to
produce a culturally competent healthcare workforce whose diversity is
representative of the U.S. population.

**[The Specific Goals of the COE are to demonstrate]{.underline}:**

-   Institutional commitment to URM populations with a focus on minority
    health issues and eliminating health disparities.

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-   Innovative methods to strengthen or expand educational programs to
    enhance academic performance of URM students of the school.

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-   Cultural competence of health professions educators, students, and
    graduates of the health profession school.

-   Models of URM faculty development and retention, multicultural
    curricula, and faculty and student research as it relates to
    minority health issues.

**[COE Legislative Requirements]{.underline}**

Applicants should address **[each]{.underline}** of the following six
legislative requirements.

1.  **Student Performance:** To establish, strengthen, or expand
    programs to enhance the academic performance of URM students
    attending the school.

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2.  **Faculty Development:** To improve the capacity of such schools to
    train, recruit, and retain URM faculty including payment of such
    stipends and fellowships as the Secretary may determine is
    appropriate.

3.  **Information Resources,** **Clinical Education, Curricula, and
    Cultural Competence:** To carry out activities to improve the
    information resources, clinical education, curricula and cultural
    competence of the graduates as they relate to minority health
    issues.

> 4\. **Faculty/Student Research:** To facilitate faculty and student
> research on health issues particularly affecting URM groups, including
> research on issues relating to the delivery of health care.
>
> 5\. **Student Training in Providing Health Care Services:** To carry
> out a program that trains students of the school in providing health
> care services to a significant number of URMs at community-based
> health facilities that provide health care services and are located at
> a site away from the main teaching facilities of the school.

6.  **Competitive Applicant Pool:** To develop a large competitive
    applicant pool through linkages with institutions of higher
    education, local school districts, and other community-based
    entities and establish an educational pipeline for health
    professions careers.

2.) Background

The Centers of Excellence program is designated to support programs of
excellence in health professions education for Under Represented
Minority (URM) individuals in designated health professions schools. URM
is defined as racial and ethnic populations who are under-represented in
the designated health profession discipline relative to the number of
individuals who are members of the population involved. This definition
would include Black or African American, American Indian or Alaska
Native, Native Hawaiian or Other Pacific Islander, Hispanic or Latino,
and any Asian **[other than]{.underline}** Chinese, Filipino, Japanese,
Korean, Asian Indian or Thai.

Designated health professions schools, under Section 736 of the Public
Health Service Act, include such schools that meet the required general
conditions regarding: a.) certain Historically Black Colleges and
Universities, b.) Hispanic individuals, c) Native American Individuals,
and d) enrollment of URM above the national average for such enrollments
of health professions schools (see Eligibility and General Conditions).
The COE grants and contracts may also be used for other public and
nonprofit health or educational entities for the purpose of assisting
the schools in supporting programs of excellence in health professions
education for URM students.

The COE Program was established to be a catalyst for institutionalizing
a commitment to URM students and faculty and to serve as a national
resource and educational center for diversity and minority health
issues.

[]{#__RefHeading___Toc83201459 .anchor}[II. AWARD
INFORMATION]{.underline}

[]{#__RefHeading___Toc83201460 .anchor}1.) Type of Award

Funding will be provided in the form of a 3-year grant.

**Please note: [COE funds at the health professions school are limited
to one discipline per grant]{.underline}.**

[]{#__RefHeading___Toc83201461 .anchor}2.) Summary of Funding

Program will provide funding during Federal fiscal years 2006 -2008.
Approximately \$15,542,630 is expected to be available yearly to fund 11
new grantees. Funding beyond first year is dependent on the availability
of appropriated funds for the Centers of Excellence Program in FY 2007,
grantee satisfactory performance, and a decision that funding is in the
best interest of the Federal government.

[]{#__RefHeading___Toc83201462 .anchor}[IiI. ELIGIBILITY
INFORMATION]{.underline}

[]{#__RefHeading___Toc83201463 .anchor}**1.) Eligible Applicants**

Eligible applicants are accredited allopathic schools of medicine,
osteopathic medicine, dentistry, pharmacy, or graduate programs in
behavioral or mental health, or other public and nonprofit health or
educational entities including faith-based and community organizations
that meet the requirements of section 736(c) of the PHS Act, as amended.
See minimum student enrollment requirements under "Designations of
Centers of Excellence."

**Due to the limited numbers of URM students enrolled in graduate
programs in marriage and family therapy and professional counseling,
these programs are encouraged to form linkages with eligible COE
applicants. The purpose of these arrangements shall be to carry out
activities that will build the competitive pool of students applying and
obtaining admission to these programs.**

[The COE grant programs may operate only]{.underline} in the 50 States,
the District of Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of Northern Mariana Islands, the Virgin Islands, Guam,
American Samoa, the Republic of Palau, the Republic of the Marshall
Islands, and the Federated States of Micronesia.

**Designations of Centers of Excellence:**

#### A.) Historically Black Colleges and Universities (Four Designated HBCUs): 

####  Eligibility under this category is limited to certain accredited HBCUs as described in section 799B(1) of the PHS Act which received a contract under section 788B of the PHS Act (Advanced Financial Distress Assistance) for Fiscal Year l987 as such section was in effect for such fiscal year. The four designated schools are: Meharry School of Dentistry; Meharry School of Medicine; Tuskegee School of Veterinary Medicine; and Xavier School of Pharmacy. In addition to carrying out the legislative requirements of the COE, these designated institutions also may utilize the funds awarded for the following purposes:

-   to develop a plan to achieve institutional improvements, including
    financial independence, to enable the school to support programs of
    excellence in health professions education for URM individuals; and

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-   to provide improved access to the library and informational
    resources of the school.

**These four designated HBCUs are encouraged to form linkages
(partnerships with other entities).** The purpose of the linkages is to
identify URM students who are interested in a health professions career
and to facilitate the educational preparation of students who
participated in enhancement programs at the undergraduate level or other
pre-admission programs.

#### B.) Hispanic COEs: 

> Eligibility for this category **[requires]{.underline}** that a school
> give priority to carrying out the COE legislative requirements with
> respect to Hispanics. The following table specifies the minimum
> Hispanic student enrollment requirement for a school or graduate
> program to qualify as a Hispanic COE applicant.

####### **Health Professions Schools Eligibility for Hispanic Centers of Excellence**

  ---------------------------- ------------------------------------------
  **Health Professions         **Minimum \# of Hispanic Students
  School**                     Enrolled\***

  **Schools of Dentistry**     **20**

  **Allopathic Schools of      **20**
  Medicine**                   

  **Osteopathic Schools of     **20**
  Medicine**                   

  **Schools of Pharmacy**      **20**

  **Clinical Psychology**      **20**

  **Clinical/Medical Social    **30**
  Work**                       
  ---------------------------- ------------------------------------------

\*These numbers are derived from a comparison of health professions
schools and are determined based on Hispanic enrollment of the upper 20%
at such schools.

> In addition to meeting and [carrying out the legislative
> requirements]{.underline} on page 1, the health professions school
> **[will]{.underline}:**

-   establish a linkage with one or more public or nonprofit
    community-based Hispanic- serving organizations, or public or
    nonprofit private institutions of higher education, including
    schools of nursing, whose enrollment of students has traditionally
    included a significant number of Hispanic individuals. The purpose
    of the linkages is to carry out programs that identify Hispanic
    students who are interested in a career in the health professions
    involved, facilitate educational preparation to enter the health
    professions school, recruit Hispanic students who participated in
    enhancement programs at the undergraduate level or other
    matriculation programs, and assist Hispanic students in completing
    the educational requirements for a degree from a designated health
    professions school.

#### C.) Native American Centers of Excellence:

> Eligibility for this category requires that a school
> **[should]{.underline}** give priority to carrying out the COE
> legislative requirements with respect to Native Americans. Applicants
> may form a consortium of schools that [collectively]{.underline} meet
> the Native American COE conditions without regard as to whether the
> schools individually meet such conditions.
>
> The following table specifies the minimum Native American student
> enrollment requirement for a school or graduate program to qualify as
> a Native American COE applicant.

###### 

###### Health Professions Schools Eligibility for Native American Center of Excellence

  ------------------------- ---------------------------------------------
  **Health Professions      **Minimum \# of Native American Students
  School**                  Enrolled \***

  **Schools of Dentistry**  **6**

  **Allopathic Schools of   **8**
  Medicine**                

  **Osteopathic Schools of  **5**
  Medicine**                

  **Schools of Pharmacy**   **5**

  **Clinical Psychology**   **\*\***

  **Clinical/ Medical       **\*\***
  Social Work**             
  ------------------------- ---------------------------------------------

\*These numbers are derived from a comparison of health professions
schools and are determined based on Native American enrollment of the
upper 20% at such schools.

\*\* Due to the limited number of Native Americans enrolled in graduate
programs in

> clinical psychology and clinical social work, these programs are
> encouraged to address building a competitive applicant pool by linking
> with another eligible Native American COE applicant.
>
> In addition to meeting and [carrying out the legislative
> requirements]{.underline} on page 1, the health professions school
> **[should]{.underline} also agree to:**

-   Establish a linkage with one or more public or nonprofit private
    institutions of higher education, including schools of nursing,
    whose enrollment of students has traditionally included a
    significant number of Native American individuals, e.g., Tribal
    Colleges and Universities. The purpose of the linkages is to carry
    out programs that identify Native American students who are
    interested in a career in the health professions involved,
    facilitate the educational preparation to enter the health
    professions school, recruit Native American students who have
    participated in enhancement programs at the undergraduate level or
    other matriculation programs, and assist Native American students
    regarding the completion of the educational requirements for a
    degree from a designated health professions school.

#### D.) "Other" Centers of Excellence:

Eligibility for this category **[requires]{.underline}** that a school
give priority to carrying out the duties of the COE legislative
requirements with respect to URMs. In addition, the applicant
**[must]{.underline}** have an enrollment of URMs [above the national
average]{.underline} for such enrollments of health professions schools.
**Applicants applying for the "Other" COE category are encouraged to
form appropriate linkages to carry out program requirements**.

> The following table specifies the minimum URM student enrollment
> requirement for a school or program to qualify as an "Other" COE
> applicant.

####### 

####### **Health Professions Schools Eligibility for "Other" Center of Excellence**

+---------------------------+------------------------------------------+
| **Health Professions      | ###### Percent of URMs Enrolled\*        |
| School**                  |                                          |
+---------------------------+------------------------------------------+
| **Schools of Dentistry**  | **11%**                                  |
+---------------------------+------------------------------------------+
| **Allopathic Schools of   | **13%**                                  |
| Medicine**                |                                          |
+---------------------------+------------------------------------------+
| **Osteopathic Schools of  | **8%**                                   |
| Medicine**                |                                          |
+---------------------------+------------------------------------------+
| **Schools of Pharmacy**   | **14%**                                  |
+---------------------------+------------------------------------------+
| **Clinical Psychology**   | **14%**                                  |
+---------------------------+------------------------------------------+
| **Clinical Social Work**  | **22%**                                  |
+---------------------------+------------------------------------------+

\* These percentages are based on the national average of the URM
population, per

designated health profession school, rounded up to the nearest whole
number.

[]{#__RefHeading___Toc83201464 .anchor}2.)
[]{#__RefHeading___Toc83201465 .anchor} Cost Sharing/Matching

There are no Cost Sharing/Matching requirements for the Centers of
Excellence Program.

**3.) Other - Maintenance of Effort**

Grant funds shall not be used to supplant current funding for activities
described in the application. The grantee must agree to maintain
non-Federal funding for grant activities at a level, which is not less
than expenditures for such activities during the fiscal year prior to
receiving the grant. A Maintenance of Effort form is provided in this
application (COE Suggested Template D, pg 54).

[]{#__RefHeading___Toc83201467 .anchor}[IV. APPLICATION AND SUBMISSION
INFORMATION]{.underline}

[]{#__RefHeading___Toc83201468 .anchor}1.) Address to Request
Application Package

[]{#__RefHeading___Toc83201469 .anchor}*Application Materials*

Applicants should submit proposals using the appropriate HRSA Training
Grant Application Forms 6025 and COE Suggested Templates included in
this guidance. These forms and templates contain additional instructions
for the grant application. These forms and suggested templates may also
be obtained by:

\(1\) Downloading from <http://www.hrsa.gov/grants/forms.htm>

**Or**

\(2\) Contacting the HRSA Grants Application Center at:

The Legin Group, Inc.

901 Russell Avenue, Suite 450

Gaithersburg, MD 20879

Telephone: 877-477-2123

<HRSAGAC@hrsa.gov>

Instructions for preparing portions of the application that should
accompany HRSA Training

Grant Application Forms appear in the "Application Format" section
below.

[]{#__RefHeading___Toc83201470 .anchor}2.) Content and Form of
Application Submission

> ***Application Format Requirements***
>
> If applying on-line, the total size of all uploaded files **may not
> exceed the equivalent of 80 pages when printed by HRSA, approximately
> 10 MB.** **This 80-page limit includes the abstract, project and
> budget narratives, attachments, appendices and letters of commitment
> and support.**
>
> If applying on paper, **the entire application may not exceed 80 pages
> in length.** Pages must be numbered consecutively.
>
> **Applications, whether submitted on paper or electronically, that
> exceed the specified limits (80 pages or approximately 10 MB, or that
> exceed 80 pages when printed by HRSA) will be deemed non-compliant.
> All non-compliant applications will be returned to the applicant
> without further consideration.**

a.  Number of Copies (Paper Applications only)

> []{.mark}
>
> Please submit one (1) original and two (2) unbound copies of the
> application.
>
> Please do not bind or staple the application. Application must be
> single sided.

b.  Font

> []{.mark}
>
> Please use an easily readable serif typeface, such as Times Roman,
> Courier, or CG Times. The text portion of the application must be
> submitted in not less than 12 point and 1.0 line spacing. Applications
> not adhering to 12 point font requirements may be returned.
>
> []{.mark}

c.  Paper Size and Margins

> For scanning purposes, please submit the application on 8 ½" x 11"
> white paper. Margins must be at least one (1) inch at the top, bottom,
> left and right of the paper. Please left-align text.

[]{.mark}

d.  Numbering

> Please number the pages of the application sequentially from page 1
> (face page) to the end of the application, including charts, figures,
> tables, and appendices.

e.  Names

> Please include the name of the applicant on each page.

f.  Section Headings

> Please put all section headings flush left in bold type.

[]{#refheading___toc83201472 .anchor}*Application Format*

Applications for funding must consist of the following documents in the
following order:

[]{#__RefHeading___Toc83201473 .anchor}i.) Application Face Page

Use Form 6025-1 provided within HRSA Training Grant Application Forms
(pg 40), in the application package. Prepare this page according to
instructions provided on the form itself. For information pertaining to
the Catalog of Federal Domestic Assistance, the Catalog of Federal
Domestic Assistance Number is 93.157.

**DUNS Number**

> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm )
> or call 1-866-705-5711. Please include the DUNS number next to the OMB
> Approval Number on the application face page. Applications ***will
> not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization will be required to register
> with the Federal Government's Central Contractor Registry (CCR) in
> order to do electronic business with the Federal Government.
> Information about registering with the CCR can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm ).

[]{#__RefHeading___Toc83201474 .anchor}ii.) Application Table of
Contents

Provide a Table of Contents for the **remainder** of the application
(including appendices), with page numbers (See COE Suggested Template A,
pg 46).

[]{#__RefHeading___Toc83201475 .anchor}iii.) Application Checklist

Use application form provided with the application package (COE
Suggested Template B, pg 48).

[]{#__RefHeading___Toc83201476 .anchor}iv.) Budget

Grant funds should be expended to support and expand program activities
that eliminate barriers to URM health professions education. Use
application form provided in the application package (HRSA Training
Grant Application Forms 6025-2 & 3, pg 43-45).

*[Detailed Budget]{.underline}*

The application must provide an itemized cost-effective budget (Training
Form 6025-2, pg 43), compatible with stated objectives, and a detailed
justification/rationale for each budget line item.

List the direct costs (trainee and non- trainee expenses*)* requested
for the **[initial twelve (12) month budget period]{.underline}**.
Provide additional details and narrative budget justifications on the
pages [immediately following]{.underline} the Detailed Budget Table**.
The Centers of Excellence Program request for support [may not exceed
three]{.underline} (3) [years]{.underline}.**

Identify the level of cash and/or in-kind support by the applicant in
assuming greater responsibility for costs and services associated with
the project. Detail any COE activities that have been institutionalized
by the applicant organization.

Non-federal funds and resources provided to the applicant by partners
and/or sponsors to carry out HCOP activities should also be identified.

*[Consolidated Budget]{.underline}*

With respect to [any]{.underline} Federal funds received by a Center of
Excellence and available for carrying out activities under the grant,
the applicant agrees that they will, before expending COE grant funds,
expend Federal funds obtained from sources other than this grant.

> Use HRSA Training Grant Application Form 6025-3 (page 44) to summarize
> budget data for all three years of support requested. Include totals
> for the entire project period in the last column. **[The COE support
> is limited to a 3-year project period]{.underline}.**
>
> **Indirect Costs** \-- Indirect costs are those costs incurred for
> common or joint objectives which cannot be readily identified but are
> necessary to the operations of the organization, e.g., the cost of
> operating and maintaining facilities, depreciation, and administrative
> salaries. Indirect costs may be requested at 8 percent of total
> allowable direct costs exclusive of tuition, fees, equipment and
> subcontract costs exceeding \$25,000 per subcontract or actual rate,
> whichever is less. State and local government agencies may request
> full indirect cost. If an organization applying for assistance does
> not have an indirect cost rate, the applicant may wish to obtain one
> through HHS's Division of Cost Allocation (DCA). Visit DCA's website
> at <http://rates.psc.gov/> to learn more about rate agreements, the
> process for applying for them, and the regional offices that negotiate
> them.
>
> **A. Non-trainee Expenses**
>
> **Personnel --** List participants-professional and nonprofessional-by
> name and position, or by position only if not yet filled, for whom
> salary is requested. For each participant, state the percentage of
> time or effort, in both percentage of time and/or hours to be devoted
> to the training project. Note: the sum of percentages of time or
> effort to be expended by each individual for all professional
> activities must not exceed 100 percent. For each nonprofessional,
> indicate hours per week on the project.
>
> List the total project effort, in hours or percentage of time that
> paid and volunteer personnel, (faculty, professional, technical,
> secretarial, and clerical) will devote to the project and reflect
> their contribution in the budget justification, even if funds for
> salaries have not been requested. Information on both grant and
> non-grant supported positions is essential in order for reviewers to
> determine if project resources are adequate.
>
> List the dollar amounts separately for fringe benefits and salary for
> each individual. An individual\'s salary represents the total
> authorized annual compensation that an applicant organization would be
> prepared to pay for a specified work period, regardless of whether an
> individual\'s time would be spent on government-sponsored research,
> teaching, or other activities.
>
> The base salary, for the purposes of computing charges to a DHHS
> grant, excludes income which an individual may be permitted to earn
> outside of full-time duties to the applicant organization. [Where
> appropriate, indicate whether the amounts requested for the
> professional personnel are for summer salaries or academic year
> salaries, and **include the formulas for calculating summer
> salaries**]{.underline}.
>
> Fringe benefits, if treated consistently by the grantee institution as
> a direct cost to all sponsors, may be requested separately for each
> individual in proportion to the salary requested or may be entered as
> a total if your institution has established a composite fringe benefit
> rate.
>
> An applicant organization has the option of omitting specific salary
> and fringe benefit amounts for individuals from the
> **[copies]{.underline}** of the application that are made available to
> outside reviewing groups. To exercise this option, use asterisks on
> the original and copies of the application to indicate those
> individuals for whom salaries and fringe benefits are being requested.
> However, the subtotals must still be shown. In addition, submit a copy
> of the Detailed Budget page, completed in full with the asterisks
> replaced by the amount of the salary and fringe benefits requested for
> each individual listed. This budget page will be reserved for internal
> DHHS staff use only.
>
> **Consultant Costs \--** Give name and institutional affiliation of
> each consultant, if known, and indicate the nature and extent of the
> consultant service to be performed. Include expected rate of
> compensation and total fees, travel, per diem, or other related costs
> for each consultant.
>
> **Equipment** \-- List and justify each separate item of equipment
> costing \$5,000 or more. If requesting funds to purchase equipment
> that is already available, explain the need for the duplication.
>
> **Contracts** \-- List and justify each proposed contract and provide
> a description of activities or functions to be performed. Provide a
> breakdown of and justification for costs, the basis upon which
> indirect cost charges, if any, will be reimbursed.
>
> Also indicate the type of contract proposed, the kind of organizations
> or other parties to be selected, and the method of selecting these
> parties and deliverables.
>
> **Supplies** \-- Itemize and justify how major supplies and
> expenditures, such as general office and photocopying expenses, relate
> to the project. This is required for all supplies and expenditures
> charged to grant funds. Medical/clinical supplies and drugs are not
> ordinarily acceptable.
>
> **Staff Travel** \-- Enter amount for staff travel essential to
> conducting the training project. Describe the purpose of the travel
> stating the number of trips involved, the destinations, and the number
> of individuals for whom funds are requested. Note: travel costs for
> consultants should be included under \"Consultants.\" If funded, the
> project director will be expected to attend a one day meeting in the
> Washington, DC area during the project period.
>
> **Other Expenses** \-- List and justify other expenses by major
> categories. Do not include items that properly belong in one of the
> other categories.
>
> **Funds may be requested to support appropriate and justifiable costs
> that**
>
> **are directly related to meeting data reporting requirements, i.e.,
> the hiring of a**
>
> **data specialist is strongly encouraged**.
>
> **B. Trainee Expenses**
>
> Requests for stipends for students participating in training programs
> should be entered in the \"Trainee Expenses\" section of the
> application. Enter the number of students and the total amount
> requested under "Stipend."
>
> **Faculty Fellowships and Stipends -** Faculty fellowships are to be
> incorporated into a formal minority faculty development program.
> [Selection criteria will be established in concert with the sponsoring
> Chair and the institutional COE program director]{.underline}. It is
> anticipated that institutional commitment will be addressed in
> retention efforts to hire fellows in training as full-time faculty
> after successful completion of fellowship training program. Fellowship
> support awarded will be limited to the amount of \$44,364 or 50% of
> salary (whichever is less) for a maximum of 2 years. Activities to be
> included are training in pedagogical and research methods, and
> mentoring by senior faculty. The institution may request tuition and
> fees, including appropriate health insurance, only to the extent that
> the same resident or nonresident tuition and fees are charged to
> regular non-federally supported fellows. A maximum amount of \$5,000
> may be requested for travel and other expenses to attend professional
> meetings.
>
> **Student Stipends -** Stipends for student participants may be
> awarded only to URM individuals to assure participation and provide
> support needed to participate in structured programs of the COE
> Program. **Stipends are for students matriculating at the applicant
> institution ONLY.**
>
> Such stipends shall be an amount deemed appropriate and must be
> justified. It is the responsibility of the grantee to document the
> basis for grant expenditures related to trainee stipends. Stipends to
> individual participants may be provided **only** when a determination
> has been made that no other Federal financial assistance program is
> authorized to provide this support.
>
> Post-Baccalaureate Conditional Acceptance Program stipends should be
> done according to the COE Post-Baccalaureate program requirements.
>
> Stipend should be entered in the \"Total Trainee Costs." Enter
> \"Trainee Travel\" for students as a separate item on the appropriate
> line. Add the figures for \"Total Trainee Costs\" and \"Trainee
> Travel\" and enter as the \"Subtotal‑Trainee Expenses.\"
>
> **Tuition and Fees** \-- Except for the faculty fellowship component
> of COE, tuition and fees are not allowable.

v.) Budget Justification

> Provide a narrative that explains the amounts requested for each line
> in the budget. **The budget justification should specifically describe
> how each item will support the achievement of proposed objectives.**
> The budget period is for ONE year. However, the applicant must submit
> one-year budgets for each of the subsequent project period years
> (usually one to three years or more) at the time of application. Line
> item information must be provided to explain the costs entered in
> appropriate form. The budget justification must clearly describe each
> cost element and explain how each cost contributes to meeting the
> project's objectives/goals. Be very careful about showing how each
> item in the "other" category is justified. The budget justification
> MUST be concise. Do NOT use the justification to expand the project
> narrative.
>
> **Budget for Multi-Year Grant Award**
>
> This announcement is inviting applications for project periods up to 3
> years. Awards, on a competitive basis, will be for a one-year budget
> period, although project periods may be for three years. Applications
> for continuation grants funded under these awards beyond the one-year
> budget period but within the three year project period will be
> entertained in subsequent years on a noncompetitive basis, subject to
> availability of funds, satisfactory progress of the grantee and a
> determination that continued funding would be in the best interest of
> the Government.

**For further guidance on use of grant funds, you may contact the
Division of Grants Management Operations office at (301) 443-6960.**

[]{#__RefHeading___Toc83201478 .anchor}vi.) Staffing Plan and Personnel
Requirements

> Applicants must present a staffing plan and provide a justification
> for the plan that includes education and experience qualifications and
> rationale for the amount of time being requested for each staff
> position. Position descriptions that include the roles,
> responsibilities, and qualifications of proposed project staff must be
> included in the Appendix. Copies of biographical sketches for any key
> employed personnel that will be assigned to work on the proposed
> project must be included in the Appendix.
>
> Applicant must complete a Biographical Sketch for any key personnel
> assigned to work on the proposed project must be completed on COE
> Suggested Template C entitled "Biographical Sketch" (page 53).

[]{#__RefHeading___Toc83201479 .anchor}vii.) Assurances

Please refer to section VIII "Other Information" (page 32) and complete
COE Suggested

Template B, page 48.

viii.) Certifications and Other Requirements

Please refer to section VIII "Other Information" (page 32) and complete
COE Suggested

Template B, page 48.

[]{#__RefHeading___Toc83201483 .anchor}ix.) Project Abstract

> Provide a 1-page summary of the application. Because the abstract is
> often distributed to provide information to the public and Congress,
> please prepare this so that it is clear, accurate, concise, and
> without reference to other parts of the application. It must include a
> brief description of the proposed grant project including the needs to
> be addressed, the proposed services, and the population group(s) to be
> served.

Please place the following at the top of the abstract:

-   Project Title

-   Applicant Name

-   Address

-   Contact Phone Numbers (Voice, Fax)

-   E-Mail Address

-   Web Site Address, if applicable

The project abstract must be single-spaced and limited to one page in
length. The abstract should clearly and completely describe the project
as a whole. If the application is approved and funded, the abstract will
become public information on HRSA's website. **Number this page**.
(**Please note that this page is counted in the 80 page limit).**

[]{#__RefHeading___Toc83201484 .anchor}x.) Program Narrative

> This section provides a comprehensive framework and description of all
> aspects of the proposed program. It should be succinct,
> self-explanatory, and well organized so that reviewers can understand
> the proposed project.

Use the following section headers for the Narrative:

A\) Introduction

> This section should briefly describe the purpose of the proposed
> project.

B\) InSTITUTIONAL COMMITMENT

> The application should reflect the institution's commitment to serve
> as a resource to recruit, train, and retain underrepresented minority
> students and faculty in health professions schools. It should
> summarize past educational and training initiatives, achievements and
> performance to include outcomes of these efforts. In addition,
> applicant should discuss the institution's recruitment efforts
> targeting URMs to enroll in and graduate from the school and to serve
> in faculty and/or administrative positions. The application should
> reflect the institution's commitment to developing a culturally
> competent health professions workforce by establishing a system that
> values the importance of culture in the delivery of health are
> services to all segments of the population.
>
> Describe the number of URM individuals enrolled in the school,
> including individuals accepted for enrollment and strategies that have
> been effective in assisting URM students to successfully complete a
> program and receive the degree involved. Applicant should discuss the
> number of URMs that have graduated over the past 5 years.

C\) NEEDS ASSESSMENT

The needs assessment section of the proposal should show the degree to
which the applicant recognizes problems and needs relating to:

**Cultural Competence:**

-   The development of a culturally competent health care work force.

-   Barriers to the delivery of culturally competent health care.

> **Students:**

-   Barriers that exist, at any point along the educational pipeline,
    that ultimately affect a student's competitiveness to enter and
    graduate from health profession schools;

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-   Academic difficulties that are likely to be faced by
    under-represented minorities in taking exams such as the United
    States Medical Licensing Examination (USMLE).

> **Faculty Development:**

-   Barriers to building capacity to train, recruit, and retain URM
    faculty.

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-   Difficulties in developing an effective URM Faculty Development Plan
    that clearly shows the progression of junior and clinical faculty.

-   Obstacles that preclude the institution from providing professional
    support in activities that prepare URM faculty for research,
    grant/publication writing, and community service.

-   Deficiencies in preceptor/mentor programs.

-   Incentives that are used to retain URM faculty; and

-   Changes in the numbers of URM faculty over the past
    **[5]{.underline}** years.

> **Geographic area:**

-   The geographic area that the project will focus on (e.g. local and
    regional focus)?

> **Need for Health Professionals:**

-   Health Professions Shortage Areas (HPSAs) that exist in the
    geographic area, including the need for health services.

-   Diversity of the current workforce in the geographic area of the
    proposed project.

D\) cultural competence development

The applicant should demonstrate COE specific courses and/or activities,
appropriate to the educational level, which develop students' knowledge
and appreciation of how culture impacts health. COE Cultural Competence
activities should facilitate the enhancement of key tools and skills
that improve the ability of program participants to effectively
communicate and provide services to patients from diverse social and
cultural backgrounds. The applicant should describe specific qualitative
and quantitative outcome measures for each Cultural Competence objective
and activity

(see examples of cultural competency training activities on page 18).

**This section includes the cultural competence objectives, methodology,
evaluation and budget item section arranged in the following format:**

###### [Cultural Competence Objective 1]{.underline}

###### [Methodology for Objective 1]{.underline}

[Evaluation for Objective 1]{.underline}

[Budget Items for Objective 1]{.underline}

e\) methodology, workplan & evaluation

Methodology should address:

-   What the institution is going to do;

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```
-   How the institution is going to do it;

-   Who is doing it, and their qualifications; and

-   How it is going to be evaluated.

> Describe in detail the specific activities, methods, techniques, and
> resources proposed to achieve each stated objective, making sure they
> relate to the legislative requirements.
>
> Describe the intervention(s) that defines the process and desired
> outcomes. The description should encompass information about what,
> how, when, for whom, by whom, and where the activity will be
> conducted. This includes nontraditional methods that may produce
> positive outcomes resulting from community and other sources that
> assist and support the project's success.
>
> The applicant should provide a workplan that includes a timetable and
> identifies persons responsible for implementing activities that will
> support the objectives. Present the activities in a logical,
> sequential manner, clearly indicating when specific activities will
> take place.
>
> When writing the objectives, the applicant **[must]{.underline}**
> address the legislative requirements and review criteria for the COE.
> The objectives must be measurable ([using baseline data]{.underline})
> with specific outcomes for each budget period of the project. Targeted
> students and/or faculty (number and demographics) should be identified
> for each objective, where applicable. Objectives should be realistic
> and have a projected time frame for achievement.

**This section includes the objectives, methodology, evaluation and
budget item sections arranged in the following format:**

###### [Objective 1]{.underline}

###### [Methodology for Objective 1]{.underline}

[Evaluation for Objective 1]{.underline}

[Budget Items for Objective 1]{.underline}

> Evaluation strategy **must** be tied explicitly to the project
> objectives and the proposed performance outcomes. Specify qualitative
> and quantitative outcome measures for each objective and activity.
> Describe in detail the methods by which data will be collected, the
> personnel who will be responsible, and the manner in which data will
> be analyzed and reported. Data analysis and reporting
> [must]{.underline} facilitate evaluation of the project outcomes.

The budget items section for each objective **must** list budget items
requested in the detailed budget for carrying out this particular
objective (do not include dollar amounts); enable reviewers to correlate
project expenses with specific legislative requirements; and assist
reviewers in determining what objectives and program purposes are being
supported by the grant and/or the institution and to what extent.

**F) DISSEMINATION OF PROJECT RESULTS**

> Clearly delineate a plan for disseminating the project results to the
> health professions education community regionally or nationally.

G\) Progress SUMMARY

**[For competing continuation applicants only]{.smallcaps}**. The
progress summary is an important source of information in the peer
review process for demonstrating project effectiveness**. The progress
summary should be a presentation of the outcomes and impact, in relation
to the objectives of the grant during the current project period**

**(entire 3 year period).** Data consistency throughout the progress
summary is an essential element.

**[The summary should include]{.underline}**:

1\. **The period covered** (dates)

All activities related to the current project period.

2\. **Specific objectives**

Restate the original project objectives as actually funded and use this
as a baseline

> in demonstrating project performance.

3\. **Outcomes**

> For each of the original project objectives, summarize the activities
> conducted to achieve and measure these objectives. Summarize the
> accomplishments of the activities with specific results for each
> objective. Show outcomes (results) of each objective using
> quantitative and qualitative measures including actual numbers and
> percentages. Indicate baselines by which outcomes (results) are
> measured. Include negative results or technical problems and
> corrective measures planned. Include identifiers for faculty and
> student participants and describe the activities in which they
> participated in. Also include the outcomes (results) of the
> activities.

4\. **Evaluation**

> This section differs from outcomes. Outcomes are the results that
> include methodologies used. Evaluation is the actual impact the
> results had on the stated objectives. In the narrative, state whether
> your results actually made a difference (impact) on the project
> objectives. Include quantitative and qualitative data to show impact.
> **If results fall short of stated objectives, include any corrective
> measures for future objectives**.

5\. **Staffing modifications for the current project period**

> Discuss any staffing changes, relating to the COE project, including
> additions and deletions of positions. Provide qualifications of new
> staff, both COE and non‑COE supported. Indicate the reasons why funded
> positions were not filled. Discuss the impact on the project due to
> the unfilled positions, and expectations for staffing the positions.

6.  **Linkages**

> In the progress report, grantees are expected to report on any
> linkages by providing the name of the entity, the site of the
> activity, the kind of program offered, and the number of participants
> attending the program activity.

**Examples of Cultural Competence Training Activities**

Methods to address cultural competence development may include but are
not limited to:

+------+-------------------+------------+------------------+-----------+
| **   | *Activity         | *          | *                | **Goals** |
| Cult | (describe         | Objectives | Outcomes(include |           |
| ural | activity and its  | (should be | qualitative and  |           |
| Co   | key components)*  | measurable | quantitative     |           |
| mpet |                   | and        | outcome          |           |
| ency |                   | at         | measures)*       |           |
| Tr   |                   | tainable)* |                  |           |
| aini |                   |            |                  |           |
| ng** |                   |            |                  |           |
+------+-------------------+------------+------------------+-----------+
| **   | ***Model          | Improve    | Equip students   | -C        |
| Teac | Curriculum*** - A | knowledge  | with the         | ulturally |
| hing | model cultural    | of         | knowledge and    | competent |
| Deli | competence        | cultu      | tools needed to  | health    |
| very | curriculum either | res/ethnic | provide quality  | care      |
| M    | as a required     | b          | and cultural     | workforce |
| etho | course, elective, | ackgrounds | competent health | that will |
| ds** | or unit in an     | through    | care services.   | improve   |
|      | established       | various    |                  | access,   |
|      | course, including | teaching   |                  | quality,  |
|      | didactic          | methods    |                  | and       |
|      | teaching, problem |            |                  | patient   |
|      | based/ small      |            |                  | adherence |
|      | group learning,   |            |                  | to        |
|      | e-learning,       |            |                  | medical   |
|      | videotapes/DVD,   |            |                  | advice/t  |
|      | simulated         |            |                  | reatment. |
|      | activities,       |            |                  |           |
|      | health literacy   |            |                  | -Reduce   |
|      | training, and     |            |                  | h         |
|      | c                 |            |                  | ealthcare |
|      | ultural/community |            |                  | di        |
|      | immersion         |            |                  | sparities |
|      |                   |            |                  |           |
|      |                   |            |                  | -U        |
|      |                   |            |                  | ltimately |
|      |                   |            |                  | eliminate |
|      |                   |            |                  | health    |
|      |                   |            |                  | care      |
|      |                   |            |                  | di        |
|      |                   |            |                  | sparities |
+------+-------------------+------------+------------------+-----------+
|      | ***Clinical       | Expose     | Increased        |           |
|      | Cl                | students   | efficacy in      |           |
|      | erkships/Field*** | to the     | delivering       |           |
|      |                   | community  | health services  |           |
|      | > ***Placement*** | in which   | to diverse       |           |
|      | > -- program      | they will  | ethnic           |           |
|      | > participants    | be         | populations by   |           |
|      | > are placed in   | working.   | integrating      |           |
|      | > clinical        |            | cultural         |           |
|      | >                 | Gain       | diversity        |           |
|      |  clerkships/field | knowledge  | training into    |           |
|      | > placements in   | of the     | clinical         |           |
|      | > community-based | community  | practice         |           |
|      | > settings with   | epi        |                  |           |
|      | > diverse ethnic  | demiology, | Increased        |           |
|      | > populations or  | community  | understanding of |           |
|      | > language        | resources, | community and    |           |
|      | > groups, or with | and role   | cultural         |           |
|      | > populations     | of         | perspectives     |           |
|      | > that have been  | pr         |                  |           |
|      | > traditionally   | eventative |                  |           |
|      | > medically       | health     |                  |           |
|      | > underserved.    | care       |                  |           |
|      | > Program         |            |                  |           |
|      | > participants    |            |                  |           |
|      | > may also be     |            |                  |           |
|      | > placed in       |            |                  |           |
|      | >                 |            |                  |           |
|      |  clerkships/field |            |                  |           |
|      | > placements in   |            |                  |           |
|      | > community-based |            |                  |           |
|      | > settings with   |            |                  |           |
|      | > populations     |            |                  |           |
|      | > groups with     |            |                  |           |
|      | > special needs.  |            |                  |           |
+------+-------------------+------------+------------------+-----------+
|      | ***Semi           | Su         | Enhanced         |           |
|      | nars/Workshops*** | pplemental | learning         |           |
|      | -- program        | training   | experience in    |           |
|      | participants and  | in         | cultural         |           |
|      | faculty will      | cultural   | competence       |           |
|      | attend            | competence |                  |           |
|      | s                 |            |                  |           |
|      | eminars/workshops |            |                  |           |
|      | related to        |            |                  |           |
|      | cultural          |            |                  |           |
|      | competence.       |            |                  |           |
+------+-------------------+------------+------------------+-----------+
|      | ***Cross/Cultural | Increase   | Improved skill   |           |
|      | Communication***  | knowledge  | in dealing with  |           |
|      | -- program        | of various | cross-cultural   |           |
|      | participants will | cultural   | communication in |           |
|      | learn how to      | cues and   | health care      |           |
|      | properly          | behaviors  | setting          |           |
|      | communicate with  | specific   |                  |           |
|      | different         | to         |                  |           |
|      | cultural/ ethnic  | different  |                  |           |
|      | populations (     | cultu      |                  |           |
|      | e.g. Medical      | ral/ethnic |                  |           |
|      | Spanish course,   | groups     |                  |           |
|      | interpreter       |            |                  |           |
|      | issues, health    | Improve    |                  |           |
|      | literacy, and     | skill in   |                  |           |
|      | cultural          | com        |                  |           |
|      | communication     | municating |                  |           |
|      | regarding         | to wide    |                  |           |
|      | cultural          | array of   |                  |           |
|      | cues/behaviors)   | patients   |                  |           |
+------+-------------------+------------+------------------+-----------+
| **   | ***R              | Exposure   | Increased        |           |
| Non- | esearch/Scholarly | to         | efficacy in      |           |
| Teac | Activities        | different  | confronting      |           |
| hing | Pertaining to     | ethnic/    | health issues    |           |
| Deli | People of         | cultural   | specific to      |           |
| very | Color*** --       | group      | different        |           |
| M    | academic or       | e          | cultural/ethnic  |           |
| etho | community-based   | xperiences | groups           |           |
| ds** | research about    |            |                  |           |
|      | minorities and    |            |                  |           |
|      | health disparity  |            |                  |           |
|      | issues            |            |                  |           |
+------+-------------------+------------+------------------+-----------+
|      | ***Resource       | Increase   | Comprehensive    |           |
|      | Center*** -- a    | av         | data base on     |           |
|      | clearinghouse of  | ailability | health issues    |           |
|      | minority health   | of data on | specific to      |           |
|      | information,      | health     | various          |           |
|      | including print,  | issues     | cultural/ethnic  |           |
|      | video, and audio  | specific   | groups in        |           |
|      | media, computer   | to various | community        |           |
|      | resources, and    | cultu      |                  |           |
|      | access to         | ral/ethnic |                  |           |
|      | national minority | groups in  |                  |           |
|      | health and health | community  |                  |           |
|      | disparity         |            |                  |           |
|      | information       |            |                  |           |
+------+-------------------+------------+------------------+-----------+
|      | > ***Community    | Par        | Development of   |           |
|      | > Partn           | ticipatory | partnerships     |           |
|      | erships-***engage | process of | with academic    |           |
|      | > community       | curriculum | institutions and |           |
|      | > members and     | d          | community to     |           |
|      | > other           | evelopment | promote cultural |           |
|      | > university      | and        | competence.      |           |
|      | > departments in  | cultural   |                  |           |
|      | > the development | competence | Enhanced         |           |
|      | > of cultural     | education  | cultural         |           |
|      | > competence      |            | competence       |           |
|      | > curriculum,     |            | training through |           |
|      | > serving as      |            | i                |           |
|      | > simulated       |            | nterdisciplinary |           |
|      | > patients,       |            | collaboration    |           |
|      | > co              |            | with other       |           |
|      | aches/instructors |            | disciplines.     |           |
|      | > for community   |            |                  |           |
|      | > immersion       |            |                  |           |
|      | > programs, and   |            |                  |           |
|      | > participation   |            |                  |           |
|      | > in community    |            |                  |           |
|      | > cultural        |            |                  |           |
|      | > activities.     |            |                  |           |
+------+-------------------+------------+------------------+-----------+

***xi*. *Appendices***

> Please provide the following items in the appendices section of your
> application to complete the content of the application. Please note
> that these are supplementary in nature, and are not intended to be a
> continuation of the project narrative..

**COE Suggested Templates:**

[Form C:]{.underline}

Biographical Sketch

[Form D:]{.underline}

Maintenance of Effort

[Form F:]{.underline}

COE Purpose Reference Table

[Form G:]{.underline}

Enrollment Tables

[Form H:]{.underline}

Student Training in Health Care Services

[Form I:]{.underline}

General Condition Guidelines

[]{.mark}

> **Include only letters of support in the appendices that specifically
> indicate a commitment to the project/program (partnerships, in-kind
> services, dollars, staff, space, equipment, etc.) Letters of
> agreements and support must be dated. List all other support letters
> on one page.**

[]{#__RefHeading___Toc83201492 .anchor}3.) Submission Dates and Times

**Application Due Date**

> The due date for applications under this grant announcement is
> ***January 26, 2006 at 5:00 P.M. ET*.**

Applications will be considered as meeting the deadline if they are
either:

\(1\) Received on or before the due date; or

> \(2\) Post marked or E marked on or before the due date, and received
> in time for the Independent Review Committee review.
>
> The Chief Grants Management Officer (CGMO) or a higher level designee
> may authorize an extension of published deadlines when justified by
> circumstances such as acts of God (e.g. floods or hurricanes),
> widespread disruptions of mail service, or other disruptions of
> services, such as a prolonged blackout. The authorizing official will
> determine the affected geographical area(s).
>
> **Electronic Submission:**
>
> Applications must be submitted by 5:00 P.M. ET. **To ensure that you
> have adequate time to follow procedures and successfully submit the
> application, we recommend you start submission no later than noon on
> the due date.** Applications submitted electronically will be
> time/date stamped electronically, which will serve as receipt of
> submission.
>
> **Paper Submission:**
>
> Upon receipt of a paper application, the Grants Application Center
> will mail an acknowledgement of receipt to the applicant
> organization's Program Director.
>
> In the event that questions arise about meeting the application due
> date, applicants must have a legibly dated receipt from a commercial
> carrier or the U.S. Postal Service. Private metered postmarks will not
> be accepted as proof of timely mailing.
>
> **Late applications:**
>
> Applications which do not meet the criteria above are considered late
> applications. Health Resources and Services Administration (HRSA)
> shall notify each late applicant that its application will not be
> considered in the current competition.

[]{#__RefHeading___Toc83201494 .anchor}4.) Intergovernmental Review

> The Centers of Excellence is a program subject to the provisions of
> Executive Order 12372, as implemented by 45 CFR 100. Executive Order
> 12372 allows States the option of setting up a system for reviewing
> applications from within their States for assistance under certain
> Federal programs. Application packages made available under this
> guidance will contain a listing of States which have chosen to set up
> such a review system, and will provide a State Single Point of Contact
> (SPOC) for the review. Information on states affected by this program
> and State Points of Contact may also be obtained from the Grants
> Management Officer listed in the AGENCY Contact(s) section, as well as
> from the following Web site:
> <http://www.whitehouse.gov/omb/grants/spoc.html>.
>
> All applicants other than federally recognized Native American Tribal
> Groups should contact their SPOC as early as possible to alert them to
> the prospective applications and receive any necessary instructions on
> the State process used under this Executive Order.
>
> Letters from the State Single Point of Contact (SPOC) in response to
> Executive Order 12372 are due sixty days after the application due
> date.

[]{#__RefHeading___Toc83201495 .anchor}5.) Funding Restrictions

This does not apply to the Centers of Excellence Program.

[]{#__RefHeading___Toc83201496 .anchor}6.) Other Submission Requirements

**Electronic Submission**

HRSA encourages applicants to submit applications on-line.

> To register and/or log-in to prepare your application, go to
> <https://grants.hrsa.gov/webexternal/login.asp>. For assistance in
> using the on-line application system, call 877-GO4-HRSA (877-464-4772)
> between 8:30 am to 5:30 pm ET or e-mail <callcenter@hrsa.gov>.
>
> Online applications are required to submit ONLY one form in signed
> hard copy: the 6025-1 Face Sheet, since all other elements of the
> application have been captured and transmitted electronically. 
>
> **Formal submission of the electronic application:** Applications
> completed online are considered formally submitted when the
> Authorizing Official electronically submits the application to HRSA.
> However, to complete the submission requirements, a hard-copy of the
> 6025-1 Face Sheet must be printed, signed, and submitted to the HRSA
> Grants Application Center. The 6025-1 can be printed from the online
> application.
>
> For an online application, the signed 6025-1 must be sent to the HRSA
> GRANTS APPLICATION CENTER at the address and received by HRSA by no
> later than five days after the application due date.
>
> Applications will be considered as having met the deadline if: (1) the
> application has been successfully transmitted electronically by your
> organization's Authorizing Official on or before the deadline date and
> time, and (2) the signed 6025-1 Face Sheet is received by HRSA no
> later than five days after the deadline date.
>
> REMINDER: Only applicants who apply online are permitted to forego
> hard-copy submission of all application forms EXCEPT the signed
> 6025-1.
>
> If the application is submitted as a hard-copy, the rules of
> submission as described elsewhere in this guidance must be followed.
>
> Application narratives and spreadsheets will need to be created
> separately and submitted as attachments to the application. You will
> be prompted to "upload" your attachments at strategic points within
> the application interface. The following document types will be
> accepted as attachments: WordPerfect (.wpd), Microsoft Word (.doc),
> Microsoft Excel (.xls), Rich Text Format (.rtf), Portable Document
> Format (.pdf). If there are tables that are not supported as data
> entry forms from within the application, they should be downloaded to
> your hard drive, filled in, and then uploaded as attachments with your
> application.
>
> Applications submitted electronically will be time/date stamped
> electronically, which will serve as receipt of submission.
>
> To look for funding opportunities, go to <http://www.hrsa.gov/grants>
> and follow the links. Information on grant opportunities both within
> HRSA and other Federal agencies is also available through
> [http://www.grants.gov](http://www.grants.gov/), the official E-Grants
> website where applicants can find and apply for federal funding
> opportunities.

**Paper Submission**

> If you choose to submit paper copy, please send the original and **2**
> copies of the application to:
>
> []{.mark}
>
> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: *Centers of Excellence (COE)*
>
> Program Announcement No. HRSA 06-021
>
> CFDA No. 93.157
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123
>
> In the event that questions arise about meeting the application due
> date, applicants must have a legibly dated receipt from a commercial
> carrier or the U.S. Postal Service. Private metered postmarks will not
> be accepted as proof of timely mailing.
>
> Whether you submit electronically or via paper, please understand that
> we will not consider additional information and/or materials submitted
> after your initial application. You must therefore ensure that all
> materials are submitted together, whether electronically or on paper.

[]{#__RefHeading___Toc83201499 .anchor}[V. APPLICATION REVIEW
INFORMATION]{.underline}

[]{#__RefHeading___Toc83201500 .anchor}1.) Review Criteria

Procedures for assessing the technical merit of grant applications have
been instituted to provide for an objective review of applications and
to assist the applicant in understanding the standards against which
each application will be judged. Critical indicators have been developed
for each review criterion to assist the applicant in presenting
pertinent information related to that criterion and to provide the
reviewer with a standard for evaluation. Review criteria are outlined
below with specific detail and scoring points.

Review Criteria are used to review and rank applications. The Centers of
Excellence program has seven (7) review criteria:

**(1) [NEED]{.underline}**

**New = 5 points, Competing Continuation = 5 points**

The needs assessment section of the proposal should show the degree to
which the applicant recognizes problems and needs relating to:

> **Students:**

a.  What are the barriers that exist, at any point along the educational
    pipeline, that ultimately affect their competitiveness to enter and
    graduate from health profession schools?

b.  What are the academic difficulties that are likely to be faced by
    under-represented minorities in taking exams such as the United
    States Medical Licensing Examination (USMLE)?

> **Faculty Development:**

-   Barriers to building capacity to train, recruit, and retain URM
    faculty.

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```
-   Difficulties in developing an effective URM Faculty Development Plan
    that clearly shows the progression of junior and clinical faculty.

-   Obstacles that preclude the institution from providing professional
    support in activities that prepare URM faculty for research,
    grant/publication writing, and community service.

-   Deficiencies in preceptor/mentor programs.

-   Incentives that are used to retain URM faculty

> **Geographic area:**

-   What is the geographic area that the project will focus on?

> **Need for health professionals:**

-   Address whether the diversity of the current workforce reflects the

> demographics of the geographic area it serves.

-   Provide the number Health Professions Shortage Areas (HPSAs) that
    exist in

> the geographic area. Describe the health services and health
> professionals
>
> needed.

-   Describe how the proposal will improve upon and perhaps change these
    needs.

**(2) [RESOURCES/CAPABILITIES]{.underline}**

**New = 20 points, Competing Continuation = 15 points**

*[Institutional Commitment]{.underline}*

Institutional Commitment can be demonstrated by addressing the
following:

a.  The health professions school has a significant number of URM
    individuals enrolled in the school, including individuals accepted
    for enrollment in the school (e.g., to assist with recruitment of
    students, it is strongly encouraged that the applicant link up with
    an existing HCOP), grant program in its geographic area. The
    applicant school must have 100% of their URM students receiving some
    type of financial assistance, if not, explain (see COE Suggested
    Template G, page 56).

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```
b.  The health professions school has been effective in assisting URM
    students of the school to complete the program of education and
    receive the degree involved; the [applicant school]{.underline} must
    have a [URM]{.underline} graduation rate of at least 85% over 4 or 5
    years. **For Native American COEs ONLY**: applicant school should
    have a URM graduation rate of at least 75% (see COE Suggested
    Template I, page 59).

> c\. The health professions school has been effective in recruiting
> URMs to enroll in and graduate from the school, including **providing
> scholarships and other financial assistance** to such individuals and
> encouraging URM students from all levels of the educational pipeline
> to pursue health professions careers (e.g., to develop financial
> profiles to reduce debt burden, assist students with financial need,
> including conventional scholarships and tuition waivers). The
> applicant should encourage URM students from all levels of the
> educational pipeline to pursue a career in health professions (e.g.,
> applicants are encouraged to link with area magnet schools, health
> sciences academies, HCOP, etc) (see COE Suggested Template I, page
> 59).
>
> d\. The health professions school has made significant recruitment
> efforts to increase the number of URM individuals serving in faculty
> or administrative positions at the school (e.g., describe the URMs
> that the applicant has recruited against the number of vacancies over
> the past 5 years); submit the applicant's faculty development plan
> endorsed by the appropriate Deans and Department Heads of the school
> (see COE Suggested Template I, page 59).

e.  The applicant has, with other health professions schools, if
    necessary, formed a consortium to carry out the legislative
    requirements of the COE. **This** **applies to Native American COE
    applicants only**.

f.  The applicant has established a linkage with one or more public or
    non-profit community based Hispanic-serving organizations or public
    or non-profit private institutions of higher education including
    schools of nursing in accordance with the eligibility criteria for
    Hispanic COEs. **This applies to Hispanic COEs ONLY.**

**(3) [IMPACT]{.underline}**

> **New= 5 points, Competing Continuation= 5 points**
>
> The applicant clearly delineates a plan for disseminating COE project
> results to the Health Professions Education community regionally or
> nationally

**(4) [RESPONSE(A & B)]{.underline}**

**4A** *[Student Performance/ Student Training / Faculty
Development]{.underline}*

> **New = 40 points, Competing Continuation = 30 points**
>
> The applicant should demonstrate how it will enhance, expand, and
> strengthen the academic performance of URM students at the school by:

-   Describing a plan of action for students experiencing academic
    difficulties;

-   Enhancing critical thinking, problem solving, reading comprehension,
    and writing skills;

-   Providing subject‑specific knowledge that will result in the
    successful completion of the health professional school course of
    study; and

-   Describing a plan for enhancing instructional support through peer
    mentoring, tutoring, developing an academic skills center and
    computer lab for individualized learning, etc.

    The applicant should describe the program to train students in
    providing health services to URMs at community based health
    facilities and/or at sites away from

    the main teaching facility (see COE Suggested Template H, pg. 58 -
    **Renewals Only**).

    The applicant should clearly demonstrate how it will improve the
    capacity to train, recruit, and retain URM faculty by:

```{=html}
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```
-   Providing a school URM faculty development plan that has input and
    endorsement from the appropriate dean and the department chairs. The
    plan should demonstrate how the junior and clinical faculty will
    progress;

-   Describing professional activities that prepare URM faculty for
    research and community service;

-   Providing professional support in developing pedagogical and
    grant/publication writing skills and assignment of preceptor/mentor;

-   Describing incentives that are used to retain URM faculty; and

-   Explain any increase, decrease, or no change in the numbers of URM
    faculty over the past **[5]{.underline}** years.

**4B** *[Information Resources, Clinical Education, and
Curricula/Competitive Applicant Pool]{.underline}*

*[Faculty Student Research]{.underline}*

**New= 15 points, Competing Continuation= 10 points**

> The applicant should clearly demonstrate activities will be
> implemented that are related to [minority health issues]{.underline}
> with regards to the following:

-   [Information resources]{.underline}: The applicant should have a
    written plan for improving information and resource support (e.g.,
    library references, journals and publications, CD ROM systems)
    related to minority health issues.

-   [Clinical education]{.underline}: The applicant should demonstrate
    evidence of clinical education exposure as it relates to minority
    health.

-   [Curricula]{.underline}: The applicant should demonstrate the
    incorporation of curricula through didactic course work pertaining
    to minority health issues.

> The applicant should demonstrate, based on the needs of the regional
> area, how a large competitive applicant pool will be developed or
> expanded through linkages by:

-   The inclusion of pre-professional comprehensive HCOP development
    programs;

    Strengthening relationships between its partners, health
    academicians, and public

    health practitioners in public agencies; and

-   Serving as a resource for pre-professional programs to improve the
    teaching,

    training and practice of health professionals.

> The applicant should demonstrate how it will facilitate the
> implementation of faculty and student research on health issues
> affecting URM groups and issues relating to the delivery of health
> care. **This activity is for the Health Profession School level
> only.**

**(5) [EVALUATIVE MEASURES]{.underline}**

**New = 0 points, Competing Continuation = 20 points**

*[Progress Report Summary]{.underline}*

> **Note: Do NOT include the DATOR form with the Progress Report**

The Progress Report should provide adequate information that
demonstrates progress towards the project meeting the objectives and
outcomes of the program.

> **[The report should include]{.underline}**:

-   **The period covered** (dates)

> All activities related to the current **project** period. This is the
> 3 years of funding, not the current budget period. **Please do not
> request more than 3 years of funding.**

-   **Specific objectives**

> Restate the original objectives of the project.

-   **Outcomes**

> For each of the stated objectives, provide outcome data in
> quantitative and qualitative terms using actual numbers and
> percentages. Indicate the [baselines]{.underline} by which outcomes
> (results) are measured.

-   Where appropriate, indicate milestones that have been achieved and
    their significance. Where milestones have not been achieved, reasons
    and a proposed revised date should be included and referred to those
    objectives that will be modified in the continuation application;

-   Note any publications arising from the project and identify research
    projects being conducted at the applicant school. Of that research,
    state how many projects are related to minority health issues.

-   **COE Suggested Template H,** Student Training in Health Care
    Services (pg 58), [must be completed]{.underline} and included as
    part of your Progress Report. **For continuation applications
    only.**

-   **Evaluation**

> Evaluation differs from outcomes. Outcomes are the direct results or
> outputs of the methodologies identified in the proposal. Evaluation
> measures the **[actual impact]{.underline}** the results had on the
> stated objectives. In the narrative, state whether your results
> actually made a difference or impact on the project objectives.
> Include quantitative and qualitative data to show impact. **If results
> fall short of stated objectives, include any corrective measures for
> future objectives**.

-   **Staffing modifications for the current project period**

> Discuss any staffing changes, relating to the COE project, including
> additions and deletions of positions. Indicate the reasons why funded
> positions were not filled. Discuss the impact on the project due to
> the unfilled positions and expectations for staffing the positions.

**(6) [SUPPORT REQUESTED]{.underline}**

**New =5 points, Competing Continuation = 5 points**

*[Budget]{.underline}*

> The overall budget, including non-trainee expenses, should be cost
> effective, reasonable and consistent with the stated objectives and
> proposed activities. Expenditures should be justified and in-kind
> contributions documented.

**(7) [cultural competence development]{.underline}**

**New= 10 points, Competing Continuation=10 points**

The applicant should demonstrate COE specific courses and/or activities,
appropriate to the educational level that develops students' knowledge
and appreciation of the impact of culture on health. COE Cultural
Competence activities should facilitate the enhancement of key tools and
skills that improve the ability of program participants to effectively
communicate and provide services to patients from diverse social and
cultural backgrounds.

In addition, the applicant should reflect the institution's commitment
to developing culturally competent health professionals by establishing
a system that values the importance of culture in the delivery of health
care services to all segments of the population. Applicant should
describe the institutional policies. Practices and initiatives, which
demonstrate the responsiveness of the institution's commitment to
increasing culturally competent and diverse health professionals.

[]{#__RefHeading___Toc83201508 .anchor}2.) Review and Selection Process

> The Division of Independent Review is responsible for managing
> objective reviews within HRSA. Applications competing for federal
> funds receive an objective and independent review performed by a
> committee of experts qualified by training and experience in
> particular fields or disciplines related to the program. In selecting
> review committee members, other factors in addition to training and
> experience may be considered to improve the balance of the committee,
> e.g. geographic distribution, race/ethnicity, and gender. Each
> reviewer is screened to avoid conflicts of interest and is responsible
> for providing an objective, unbiased evaluation based on the review
> criteria noted above. The committee provides expert advice on the
> merits of each application to program officials responsible for final
> selections for award.

[]{#__RefHeading___Toc83201509 .anchor}3.) Anticipated Announcement and
Award Dates

The anticipated date for announcement of grant awards is September 2006.

[]{#__RefHeading___Toc83201510 .anchor}[VI. AWARD ADMINISTRATION
INFORMATION]{.underline}

[]{#__RefHeading___Toc83201511 .anchor}**1.) Award Notices**

Each applicant will receive written notification of the outcome of the
objective review process, including a summary of the expert committee's
assessment of the application's merits and weaknesses, and whether the
application was selected for funding. Applicants who are selected for
funding may be required to respond in a satisfactory manner to
Conditions placed on their application before funding can proceed.
Letters of notification do not provide authorization to begin
performance. The Notice of Grant Award, which is signed by the Grants
Management Officer and is sent to the applicant agency's Authorized
Representative, is the authorizing document. It will be sent prior to
the start date of September 1, 2006.

[]{#__RefHeading___Toc83201512 .anchor}2.) Administrative and National
Policy Requirements

Successful applicants must comply with the administrative requirements
outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate.

**PUBLIC POLICY ISSUANCE**

> **Healthy People (HP) 2010** is a national initiative led by HHS that
> sets priorities for all HRSA programs. The initiative has two major
> goals: (1) To increase the quality and years of a healthy life; and
> (2) Eliminate our country's health disparities. The initiative
> consists of 28 focus areas and 467 objectives. HRSA has actively
> participated in the work groups of all the focus areas, and is
> committed to the achievement of the Healthy People 2010 goals.
>
> Applicants must summarize the relationship of their projects and
> identify which of their programs objectives and/or sub-objectives
> relate to the goals of the Healthy People 2010 initiative. **The HP
> objective number that corresponds/relates to the proposed project
> objective should be stated after the project objective**. It is not
> necessary to restate the HP 2010 objective.
>
> Copies of the Healthy People 2010 may be obtained from the
> Superintendent of Documents or downloaded at the Healthy People 2010
> website: [http://www.health.gov/healthypeople/document]{.underline}/.

[]{#refheading___toc83201514 .anchor}3.) Reporting

**Progress Reports, Final Reports and Performance (CPMS) Reports**

All Bureau of Health Professions grantees are required to submit reports
to HRSA on an annual basis. These reports take the form of Uniform
Progress Reports (UPR), Final Reports, Disadvantaged Assistance Tracking
Outcome Report (DATOR), and Comprehensive Performance Management System
(CPMS) Reports. Examples of these reports are available on the HRSA
website at: http://www.hrsa.gov/grants/preview/ta/diversity.htm. The
Bureau of Health Professions grantees will be able to access and
complete their reports on the internet using a web-based data entry
tool. Information on this new system will be updated regularly on the
Bureau's web page. Due dates for the reports will be posted on the web
page as soon as they are available. The Bureau's web page address is
[http://]{.underline}[www.bhpr.hrsa.gov/grants](http://www.bhpr.hrsa.gov/grants)[,]{.underline}
on the web page, click on **Grantee Reports.**

The successful applicant under this guidance must:

a.  Comply with audit requirements of Office of Management and Budget
    (OMB) Circular A-133. Information on the scope, frequency, and other
    aspects of the audits can be found on the Internet at
    [www.whitehouse.gov/omb/circulars](http://www.whitehouse.gov/omb/circulars);

b.  Submit a Payment Management System Quarterly Report. The reports
    identify cash expenditures against the authorized funds for the
    grant. Failure to submit the report may result in the inability to
    access grant funds. Submit report to the:

> Division of Payment Management
>
> DPM/FMS/PSC/ASAM/HHS
>
> PO Box 6021
>
> Rockville, MD 20852
>
> Telephone: (301) 443-1660;

c.  Submit a Financial Status Report. A financial status report is
    required within 90 days of the end of each grant year. The report is
    an accounting of expenditures under the project that year;

d.  Submit a Progress Report(s).

> **4.) Performance Review**
>
> HRSA's Office of Performance Review (OPR) serves as the agency's focal
> point for reviewing and enhancing the performance of HRSA funded
> programs within communities and States. On a regularly scheduled
> basis, HRSA grantees are required to participate in a performance
> review of their HRSA funded program(s) by a review team from one of
> the ten OPR regional divisions. Grantees should expect to participate
> in a performance review at some point during their project period.
> When a grantee receives more than one HRSA grant, each of the
> grantee's HRSA funded programs will be reviewed during the same
> performance review.
>
> The purpose of performance review is to improve the performance of
> HRSA funded programs. Through systematic pre-site and on-site
> analysis, OPR works collaboratively with grantees and HRSA
> Bureaus/Offices to measure program performance, analyze the factors
> impacting performance, and identify effective strategies and
> partnerships to improve program performance, with a particular focus
> on outcomes. Upon completion of the performance review, grantees are
> expected to prepare an Action Plan that identifies key actions to
> improve program performance as well as addresses any identified
> program requirement issues. Performance reviews also provide direct
> feedback to the agency about the impact of HRSA policies on program
> implementation and performance within communities and States.
>
> For additional information on performance reviews, please visit:
> <http://www.hrsa.gov/performancereview>.

[]{#__RefHeading___Toc83201515 .anchor}[VII. AGENCY
CONTACTS]{.underline}

> Applicants may obtain additional information regarding business,
> administrative, or fiscal issues related to this grant announcement by
> contacting:
>
> Shirley Defibaugh
>
> Division of Grants Management Operation, OFAM
>
> HRSA
>
> Parklawn Building, Rm. 11-11
>
> 5600 Fishers Lane
>
> Rockville, MD 20857
>
> Telephone: (301) 443-3445
>
> Fax: 301-443-6343
>
> sdefibaough@hrsa.gov
>
> For additional information related to the overall program contact:
>
> CDR Jeanean Willis, DPM
>
> Division of Health Careers Diversity and Development
>
> Bureau of Health Professions

HRSA

> Parklawn Building, Rm. 8-55
>
> 5600 Fishers Lane
>
> Rockville, MD 20857
>
> Telephone: (301) 443-4494
>
> Fax: (301) 443-4943
>
> jwillis@hrsa.gov

**Technical Assistance**

Technical assistance regarding this funding announcement may be obtained
by contacting:

> CDR Jeanean Willis, DPM
>
> Division of Health Careers Diversity and Development
>
> Bureau of Health Professions

HRSA

> Parklawn Building, Rm. 8-55
>
> 5600 Fishers Lane
>
> Rockville, MD 20857
>
> Telephone: (301) 443-4494
>
> Fax: (301) 443-4943
>
> jwillis@hrsa.gov

**Technical Assistance**

The Division of Health Careers Diversity and Development will conduct a
COE Technical Assistance Workshop during October 2005. A schedule of the
workshops is available at the following website:
<http://www.bhpr.hrsa.gov/diversity>

Answers to frequently asked questions about grants in general and this
program in particular can be found at
[http://answers.hrsa.gov](http://answers.hrsa.gov/). Additional
technical assistance regarding program questions is available from the
program officer listed below:

CDR Jeanean D. Willis, DPM E-mail <jwillis@hrsa.gov> ; Telephone:
301-443-4494;

Fax: 301-443-4943.

Information regarding the technical assistance teleconference is listed
on the HRSA web site at
[http://www.hrsa.gov/grants/default.htm.]{.underline}

Technical assistance regarding budget questions is available from HRSA's
Division of Grants Management Operations at: 301-443-6960 (telephone)
and 301-443-6343 (fax).

[]{#__RefHeading___Toc83201516 .anchor}VIII. [OTHER
INFORMATION]{.underline}

***Release of Information***

**1. [General Public Information:]{.underline}** DHHS routinely makes
available to interested persons a report listing grants awarded.
Information made available includes the title of the project, grantee
institution, project director, and the amount of the award. The Freedom
of Information Act (5 USC 552) and the associated Freedom of Information
Regulations of DHHS (45 CFR Part 5) require the release of certain
information about grants upon request. Release does not depend upon the
intended use of the information. Generally available for release upon
request are all funded grant applications, progress reports of grantees,
and final reports of any review or evaluation of grantee performance
conducted or caused to be conducted by the Department. Release is
subject to deletion of material that would affect patent or other
valuable rights.

**2. [Information Available to the Project Director:]{.underline}** The
Privacy Act of 1974 (5 USC 552a) and the associated Privacy Act
Regulations (45 CFR part 5b) give individuals the right of access, upon
request, to information in the records concerning themselves. The Act
provides a mechanism for correction or amendment of such information. It
also provides for the protection of information pertaining to an
individual, but it does not prevent disclosure if release of such
information is required under the Freedom of Information Act. If a
Privacy Act system of records applies, the name and number of the system
will be identified.

> If applicable, the Privacy Act requires that a Federal agency
> requesting information from an individual advise the individual of the
> agency's authority to make the request: whether compliance with the
> request is voluntary or mandatory, how and why the information will be
> used both inside and outside the agency, and what the consequences are
> for the individual of failing to provide all or any part of the
> requested information.
>
> The DHHS requests the information described in these instructions
> under authority of the PHS Act as amended (42 USC 289a-1). Although
> provision of the information requested is entirely voluntary, it is
> necessary for making grant award decisions. A lack of sufficient
> information may hinder DHHS's ability to review applications. This
> information will be used with the DHHS and may be disclosed outside
> the Department as permitted by the Privacy Act under the applicable
> system of records.

**3. [Government Use of Information:]{.underline}** In addition to being
used in evaluating applications, other routine uses of information can
include disclosures to the public as required by the Freedom of
Information Act, to the Congress, to the National Archives and Records
Service, to the Bureau of the Census, to law enforcement agencies upon
their request, to the General Accounting Office, and under court order.

It may also be disclosed outside of the Department if necessary for the
following purposes:

> 1\. To the cognizant audit agency for auditing;
>
> 2\. To the Department of Justice as required for litigation;
>
> 3\. To respond to an inquiry from a Congressional office about the
> record of an individual made at the request of that individual;
>
> 4\. To qualified experts not within the definition of Department
> employees as prescribed in Department regulations (45 CFR Part 5b.2,
> Purpose and Scope) for opinion as a part of the application review
> process;
>
> 5\. To a Federal agency, in response to its request, in connection
> with the letting of a contract, or the issuance of a license, grant,
> or other benefit by the requesting agency, to the extent that the
> record is relevant and necessary to the requesting agency's decision
> on the matter;

6.  To individuals and organizations deemed qualified by the DHHS to
    carry out specific research related to the review and award process
    of the DHHS;

7.  To organizations in the private sector with whom DHHS has contracted
    for the purpose of collating, analyzing, aggregating, or otherwise
    refining records in a system. Relevant records will be disclosed to
    such a contractor. The contractor shall be required to maintain
    Privacy Act safeguards with respect to such records; and

8.  To the applicant organization in connection with performance or
    administration under the terms and conditions of the award.

COE DEFINITIONS

**[Administrative Positions]{.underline}** - Key personnel who are
responsible for management at certain levels of the health professions
school. Administrative positions do **[not]{.underline}** include
clerical/secretarial positions or graduate student or teaching assistant
positions.

**[Compensation of Students]{.underline}** - Compensation in the form of
a stipend is allowable for students engaging in a structured program
and/or a meaningful research training that provides educational
experiences in research methods under the supervision of a faculty
member.

**[Community-Based Health Facilities-]{.underline}** An entity that
provides delivery of health services in a community and may include a
community hospital, community or public health center, outpatient
medical facility, rehabilitation facility, facility for long-term care,
community mental health center, migrant health center, and a facility
operated by a city or county health department that serves and supports
clinical training. These facilities usually serve a catchment area that
is not reasonably accessible to an adequately served area or a
population with special health needs.

**[Consortium]{.underline}** - A group of entities (such as colleges),
formed under a formal agreement, to undertake an enterprise beyond the
resources of any one member.

**[Cultural Competence]{.underline}** - The knowledge and interpersonal
skills that allow health professions educators and practitioners to
understand, appreciate, and respect cultural differences and
similarities within and between cultures other than their own. Cultural
competence acknowledges these variances in customs, values, beliefs, and
communication patterns by incorporating these variables in the
assessments and treatment of individuals and in the training of all
health professionals.

**[Curricula (COE)]{.underline}**- A set of courses offered constituting
an area of specialization that emphasizes or has an impact on minority
health issues.

**[Designated Health Professions School]{.underline}** - A school of
dentistry, allopathic or osteopathic medicine, pharmacy or a graduate
program in behavioral or mental health as defined in section 736(g)(1)
of the PHS Act. The designated school must have met the general
conditions and consortium as defined in the PHS Act, Section
736(c)(1)(B) & (C).

**[Designated Historically Black Colleges and
Universities]{.underline}** - The four schools described in section
799B(1) of the PHS Act that received a contract under section 788B for
fiscal year 1987, as such section was in effect for such fiscal year. In
addition to meeting the general conditions, a grant may be expended to
develop a plan to achieve institutional improvements, including
financial independence, to enable the school to support programs of
excellence in health professions education for URM individuals and to
provide improved access to the library and informational resources of
the school (PHS Act, Section 736 (c)(2)(A)(B)).

**[Faculty]{.underline}** - Appointed individuals who have the
qualifications for teaching, administrating, or conducting research at a
health professions institution. They serve as a resource to counsel,
advise and implement changes in curricula, research, and other
educational areas. For COE purposes, the emphasis will be on teaching
faculty (full- and part-time clinical and junior faculty) and to a
lesser degree on full-time research faculty.

**[General Conditions: PHS Act, Section 736 (c)(1)(B)]{.underline}** -
The conditions specified are that a designated health professions school
([a]{.underline}) has a significant number of URM individuals enrolled
in the school, including individuals accepted for enrollment in the
school; ([b]{.underline}) has been effective in assisting URM students
of the school to complete the program of education and receive the
degree involved; ([c]{.underline}) has been effective in recruiting URM
individuals to enroll in and graduate from the school, including
providing scholarships and other financial assistance to such
individuals and encouraging URM students from all levels of the
educational pipeline to pursue health professions careers; and
([d]{.underline}) has made significant recruitment efforts to increase
the number of URM individuals serving in faculty or administrative
positions at the school.

**[Graduate Programs in Behavioral or Mental Health]{.underline}** - A
graduate program in clinical psychology, clinical social work, marriage
and family therapy, or professional counseling (defined as mental health
counseling, gerontological counseling, and rehabilitation counseling).

**[a) Clinical Psychology]{.underline}** - This specialty comprises
psychologists who are trained and experienced in the delivery of
preventive, assessment, diagnostic, and intervention services relative
to the psychological and physical health of patients based on (1) having
completed scientific and professional training resulting in a doctoral
degree in psychology; (2) having completed an internship and supervised
experience in health care settings; and (3) having been licensed or
certified in their State as psychologists at the independent practice
level.

> **[b) Clinical Social Work]{.underline}** - This is a practice
> specialty of the social work profession. Its purposes are to (1)
> diagnose and treat bio-psychological disability and impairment,
> including mental and emotional disorders and developmental
> disabilities; (2) achieve optimal prevention of bio-psychosocial
> dysfunction; and (3) support and enhance bio-psychosocial strengths
> and functioning. Its practice includes interventions that are not
> limited to assessment and diagnosis, crisis intervention, psychosocial
> and psycho-educational interventions, and brief and long-term
> psychotherapies. Individuals in this profession hold a graduate
> (Master's or Doctoral) degree in social work and have the appropriate
> clinical experience to become licensed for practice in their State.
>
> **[c) Marriage and Family Therapy]{.underline}** - Individuals in this
> specialty are mental health professionals trained in psychotherapy and
> family systems that diagnose and treat mental and emotional disorders
> within the context of marriage, couples, and family systems. Marriage
> and Family Therapists have graduate training (a Master's or Doctoral
> degree) in marriage and family therapy and at least 2 years of
> clinical experience. Due to the limited number of URM students
> enrolled in graduate programs in marriage and family therapy, at this
> time these programs are encouraged to build the competitive applicant
> pool by linking with an eligible COE applicant.

**[Health Careers Opportunity Program]{.underline}** - A grant program
under PHS Act, Section 739 that provides educational assistance in the
health professions regarding individuals from disadvantaged backgrounds.

**[Health Professional Shortage Area]{.underline}** - An area in an
urban or rural area which need not conform to the geographic boundaries
of a political subdivision and which is a rational area for the delivery
of health services which the Secretary determines has a health manpower
shortage.

A population group that has been determined has such a shortage, or a
public or nonprofit private medical facility or other public facility
that the Secretary determines has such a shortage

(PHS Act, Sec. 332. \[254e\](a)(1).

**[Hispanic Centers of Excellence]{.underline}** - Any designated health
professions school that gives priority to identifying and facilitating
the educational preparation and entry of Hispanic students into the
health professions. The school will establish appropriate linkages with
one or more public or nonprofit community based Hispanic serving
organizations, or public or nonprofit private institutions of higher
education, including schools of nursing, whose enrollment of students
has traditionally included a significant number of Hispanic individuals.

The purposes of which will be to carry out a program, to identify
Hispanic students who are interested in a career in the health
profession involved, and to facilitate the educational preparation of
such students to enter the designated health professions school. The
school will make efforts to recruit Hispanic students, including
students who have participated in the undergraduate or other
matriculation programs carried out under arrangements established by the
school and will assist Hispanic students regarding the completion of the
educational requirements for a degree from the designated health
professions school (PHS Act, Section 736 (c)(3)(C)).

**[Informational Resources]{.underline}** -The collection of materials
(e.g., books, journals, newsletters, library references, and Internet
upgrades) acquired for the institution that will facilitate knowledge
that will benefit faculty and students, with special emphasis in
minority health issues.

**[Linkages]{.underline}** - Partnerships of entities that are formally
linked programmatically. Each member of the partnership must sign an
agreement by an appropriate person at the university or entity with the
authority to commit resources detailing a plan that identifies each
member's role and resources committed to the project.

**[Medically Underserved Community]{.underline}** - An urban or rural
area or population that:

> \(A\) Is eligible for designation under section 332 of the PHS Act as
> a health professional shortage area;
>
> \(B\) Is eligible to be served by a migrant health center under
> section 330, a community health center under Section 330, a grantee
> under Section 330 (relating to homeless individuals), or a grantee
> under Section 330 (relating to residents of public housing);
>
> \(C\) Has a shortage of personal health services, as determined under
> criteria issued by the Secretary under Section 1861(aa)(2) of the
> Social Security Act (relating to rural health clinics); or
>
> \(D\) Is designated by a State Governor (in consultation with the
> medical community) as a shortage area or medically under-served
> community (PHS Act, Section 799B(6)).

**[Minority Health Issues]{.underline}** - Culturally related health
factors that identify with the incidence and prevalence of diseases that
impact on racial and ethnic populations and the provision of quality
health care to such populations.

**[Native American Centers of Excellence]{.underline}** - Any designated
health professions school or **[Consortium]{.underline}** of such
schools that gives priority to identifying and facilitating the
educational preparation and entry of Native American students into the
health professions. The school will establish appropriate linkages with
one or more public or nonprofit private institutions of higher
education, including schools of nursing, whose enrollment of students
has traditionally included a significant number of Native Americans.

The purpose of linkages will be to carry out a program: to identify
Native American students, from the institutions of higher education who
are interested in health professions careers, and to facilitate the
educational preparation of such students to enter the designated health
professions school. The designated health professions school will make
efforts to recruit Native American students, including students who have
participated in the undergraduate program carried out under arrangements
established by the school and will assist Native American students
regarding the completion of the educational requirements for a degree
from the designated health professions school (PHS Act, Section 736
(c)(4)(C)).

**[Native Americans]{.underline}** - "Native Americans" includes
American Indians, Alaska Natives, Aleuts, and Native Hawaiians (PHS Act,
Section 736 (g) (3)).

**["Other" Centers of Excellence]{.underline}** - Any designated health
professions school that meets the general conditions governing
eligibility [and]{.underline} the school involved has an enrollment of
URMs above the national average for such schools enrollment of health
professions schools (PHS Act, Section 736 (c)(5)(B)).

**[Post-Baccalaureate Conditional Admissions Program]{.underline}**- The
purpose of these programs is to provide an avenue for eligible URM
students to gain admission into designated health professions schools.
To be eligible for the program, a student should have an undergraduate
degree and have applied and been denied admission to a health
professions school. Each program must select a cohort of at least seven
students for health professions schools, who\--providing they meet the
program's requirements\--will be guaranteed admission into the health
professions school, or admission into another health professions or
allied health professions school.

> Grant funds will provide stipends to the cohort for both summer
> sessions and during the academic year ([not to exceed 12
> months]{.underline}).
>
> Additionally, COE Post-Baccalaureate programs should include an
> initial diagnostic summer session, post-baccalaureate level academic
> year, pre-matriculation summer session, academic counseling, tutoring,
> and psychosocial support.

**[Pre-matriculation Program]{.underline}** - A 4- to 8-week summer
program designed to prepare COE matriculants for the rigors of the first
year professional school and to ease their transit into the health
professions curriculum.

**[Research]{.underline}** - For COE purposes, this refers to
student/faculty research training. Students learn research skills and
techniques via participation in such projects, preferably based on
minority health issues, with a faculty mentor. Seed grants are
**[not]{.underline}** allowed.

**[Saturday Academies]{.underline}**- Educational enrichment and career
support activities conducted on the weekend during the academic year for
participating students. These activities may include but are not limited
to field trips to health professions schools or health care delivery
facilities, group study sessions, preparation for pre-requisite
examinations, shadowing, tutorial assistance, improving test taking
skills, career clubs, volunteer efforts at health care delivery sites,
etc.

**[Structured Program]{.underline}** - A formal training of a specified
length with a specially designed curriculum or set of activities in
which designated COE students participate to enhance their academic
performance.

**[Under-represented Minority:]{.underline}** Means racial and ethnic
populations that are under-represented in the designated health
profession discipline relative to the number of individuals who are
members of the population involved. This definition would include Black
or African American, American Indian or Alaska Native, Native Hawaiian
or Other Pacific Islander, Hispanic or Latino and any Asian **[other
than]{.underline}** Chinese, Filipino, Japanese, Korean, Asian Indian or
Thai (PHS Act, Section 799B(10).

[]{#refheading___toc83201520 .anchor}[IX. TIPS FOR WRITING A STRONG
APPLICATION]{.underline}

> **Include DUNS Number.** You must include a DUNS Number to have your
> application reviewed. Applications ***will not*** be reviewed without
> a DUNS number. To obtain a DUNS number, access
> [www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
> 1-866-705-5711. Please include the DUNS number next to the OMB
> Approval Number on the application face page.
>
> **Keep your audience in mind.** Reviewers will use only the
> information contained in the application to assess the application. Be
> sure the application and responses to the program requirements and
> expectations are complete and clearly written. Do not assume that
> reviewers are familiar with the applicant organization. Keep the
> review criteria in mind when writing the application.
>
> **Start preparing the application early.** Allow plenty of time to
> gather required information from various sources.
>
> **Follow the instructions in this guidance carefully.** Place all
> information in the order requested in the guidance. If the information
> is not placed in the requested order, you may receive a lower score.
>
> **Be brief, concise, and clear.** Make your points understandable.
> Provide accurate and honest information, including candid accounts of
> problems and realistic plans to address them. If any required
> information or data is omitted, explain why. Make sure the information
> provided in each table, chart, attachment, etc., is consistent with
> the proposal narrative and information in other tables.
>
> **Be organized and logical.** Many applications fail to receive a high
> score because the reviewers cannot follow the thought process of the
> applicant or because parts of the application do not fit together.
>
> **Be careful in the use of appendices.** Do not use the appendices for
> information that is required in the body of the application. Be sure
> to cross-reference all tables and attachments located in the
> appendices to the appropriate text in the application.
>
> **Carefully proofread the application.** Misspellings and grammatical
> errors will impede reviewers in understanding the application. Be sure
> pages are numbered (including appendices) and that page limits are
> followed. Limit the use of abbreviations and acronyms, and define each
> one at its first use and periodically throughout application.
>
> **Print out and carefully review an electronic application**. If
> submitting electronically, print out the application before submitting
> it to ensure appropriate formatting and adherence to page limit
> requirements.

[]{#__RefHeading___Toc83201521 .anchor}x. [appendix]{.underline}

[]{#__RefHeading___Toc83201522 .anchor}HRSA Training Grant Application
Forms:

[Form 6025-1:]{.underline}

Application Face Page and Directions

[Form 6025-2:]{.underline}

Detailed Budget

[Form 6025-3:]{.underline}

Consolidated Budget

**COE Suggested Templates:**

[Form A:]{.underline}

Application Table of Contents

[Form B:]{.underline}

Checklist

[Form C:]{.underline}

Biographical Sketch

[Form D:]{.underline}

Maintenance of Effort

[Form E:]{.underline}

Summary of Project

[Form F:]{.underline}

COE Purpose Reference Table

[Form G:]{.underline}

Enrollment Tables

[Form H:]{.underline}

Student Training in Health Care Services

[Form I:]{.underline}

General Condition Guidelines

##  *Form 6025-1*

# Application Face Page

> **OMB Approval NO. 915-0060**

Expiration Date: 08/31/2006

+---------------------------+----------+-----------------+-----------+
| # DEPARTMENT OF           |          | **Date          | **Grant   |
| HEALTH AND HUMAN SERVICES |          | Received**      | Number**  |
|                           |          |                 |           |
| **Health Resources and    |          |                 |           |
| Services Administration** |          |                 |           |
|                           |          |                 |           |
| **Grant Application**     |          |                 |           |
+---------------------------+----------+-----------------+-----------+
| ## Centers of Excellence  |          | **CFDA No.      | **[DUNS   |
|                           |          | 93.157**        | No.]{.und |
|                           |          |                 | erline}** |
|                           |          | **COE**         |           |
+---------------------------+----------+-----------------+-----------+
| **1. Title of Proposal    |          |                 |           |
| *(not to exceed 56        |          |                 |           |
| spaces)***                |          |                 |           |
+---------------------------+----------+-----------------+-----------+
| **2a. Project Director,   |          | **2b. Highest   | **2c.     |
| Name *(last, first,       |          | Degree**        | Social    |
| middle initial & position |          |                 | Security  |
| title)***                 |          |                 | No.**     |
+---------------------------+----------+-----------------+-----------+
| **2d. Mailing Address     |          | **2e. E-Mail    |           |
| *(organization, street,   |          | Address**       |           |
| city, state, zip code)*** |          |                 |           |
+---------------------------+----------+-----------------+-----------+
|                           |          | **2f.           |           |
|                           |          | Department**    |           |
+---------------------------+----------+-----------------+-----------+
|                           |          | **2g. School or |           |
|                           |          | College**       |           |
+---------------------------+----------+-----------------+-----------+
| **2h. Telephone *(area    |          | **2i. Fax (area |           |
| code, number,             |          | code, number)** |           |
| extension)***             |          |                 |           |
+---------------------------+----------+-----------------+-----------+
| **3. Dates of entire      |          | **4. Applicant  |           |
| proposed project period   |          | Organization    |           |
| (This application)**      |          | *(name and      |           |
|                           |          | address)***     |           |
| > **From To**             |          |                 |           |
+---------------------------+----------+-----------------+-----------+
| **5. Congressional        |          |                 |           |
| District of Applicant     |          |                 |           |
| Other Districts that      |          |                 |           |
| Benefit Financially from  |          |                 |           |
| this Application**        |          |                 |           |
|                           |          |                 |           |
| **\                       |          |                 |           |
| _\_\_\_\_\_\_\_\_\_\_\_\_ |          |                 |           |
| \_\_\_\_\_\_\_\_\_\_\_\_\ |          |                 |           |
| _\_\_\_\_\_\_\_\_\_\_\_\_ |          |                 |           |
| \_\_\_\_\_\_\_            |          |                 |           |
| \_\_\_\_\_\_\_\_\_\_\_\_\ |          |                 |           |
| _\_\_\_\_\_\_\_\_\_\_\_\_ |          |                 |           |
| \_\_\_\_\_\_\_\_\_\_\_\_\ |          |                 |           |
| _\_\_\_\_\_\_\_\_\_\_\_** |          |                 |           |
+---------------------------+----------+-----------------+-----------+
| **6. Official in business |          | **6a. Single    |           |
| office to be contacted    |          | point of        |           |
| concerning application    |          | contact if      |           |
| *(name, title, address    |          | different from  |           |
| and telephone number)***  |          | 6**             |           |
+---------------------------+----------+-----------------+-----------+
|                           |          | **6b. E-Mail    |           |
|                           |          | address of      |           |
|                           |          | single point of |           |
|                           |          | contact**       |           |
+---------------------------+----------+-----------------+-----------+
|                           |          |                 |           |
+---------------------------+----------+-----------------+-----------+
| **7. Entity               | **8.     |                 |           |
| identification no.**      | Official |                 |           |
|                           | signing  |                 |           |
|                           | for      |                 |           |
|                           | a        |                 |           |
|                           | pplicant |                 |           |
|                           | orga     |                 |           |
|                           | nization |                 |           |
|                           | (name,   |                 |           |
|                           | title    |                 |           |
|                           | and      |                 |           |
|                           | t        |                 |           |
|                           | elephone |                 |           |
|                           | n        |                 |           |
|                           | umber)** |                 |           |
+---------------------------+----------+-----------------+-----------+
| **9. Type of organization |          |                 |           |
| *(see instructions) ***   |          |                 |           |
|                           |          |                 |           |
| **Private Nonprofit**     |          |                 |           |
|                           |          |                 |           |
| **Public (Specify         |          |                 |           |
| Federal, State, Local)    |          |                 |           |
| \_\_\_\_\_\               |          |                 |           |
| _\_\_\_\_\_\_\_\_\_\_\_** |          |                 |           |
+---------------------------+----------+-----------------+-----------+
| **10. Project Director    |          | **11. Signature |           |
| Assurance:**              |          | of person named |           |
|                           |          | in item 2a.**   |           |
| **I agree to accept       |          |                 |           |
| responsibility for the    |          | **\"PER\"       |           |
| conduct of the project    |          | signature not   |           |
| and to provide the        |          | acceptable.**   |           |
| required progress reports |          |                 |           |
| if a grant is awarded as  |          | **\_\_\         |           |
| a result of this          |          | _\_\_\_\_\_\_\_ |           |
| application.**            |          | \_\_\_\_\_\_\_\ |           |
|                           |          | _\_\_\_\_\_\_\_ |           |
|                           |          | Date            |           |
|                           |          | \_\_\_\_\_\_\   |           |
|                           |          | _\_\_\_\_\_\_** |           |
+---------------------------+----------+-----------------+-----------+
| **12. Certification and   |          | **13. Signature |           |
| acceptance**              |          | of person named |           |
|                           |          | in item 8.**    |           |
| **I certify that the      |          |                 |           |
| statements herein are     |          | **\"PER\"       |           |
| true and complete to the  |          | signature not   |           |
| best of my knowledge and  |          | acceptable.**   |           |
| accept the obligation to  |          |                 |           |
| comply with the DHHS      |          | **\_\_\_\_\     |           |
| terms and conditions if a |          | _\_\_\_\_\_\_\_ |           |
| grant is awarded as a     |          | \_\_\_\_\_\_\_\ |           |
| result of this            |          | _\_\_\_\_\_\_\_ |           |
| application. A willfully  |          | Date            |           |
| false certification is a  |          | \_\_\_\_\_\     |           |
| criminal offense (U.S.    |          | _\_\_\_\_\_\_** |           |
| Code, Title 18, Section   |          |                 |           |
| 1001).**                  |          |                 |           |
+---------------------------+----------+-----------------+-----------+

**HRSA-6025-1 (Formerly PHS-6025-1)(Revised 6/00)**

**Face Page Directions**

1\. **Title of Proposal**- Enter a descriptive title for this project.
Do not exceed 56 characters.

2a. **Project Director** - Designate the [individual]{.underline} who
will direct and be responsible to the applicant institution for the
proposed project.

2b. **Highest Degree** - Enter the highest degree earned by the project
director.

2c. **Social Security Number** -- To ensure privacy, we are neither
requesting nor accepting Social Security Numbers.

2d. **Mailing Address** - Enter the office address of the project
director if different from address in item 4.

2e. **E-Mail Address** - Enter the address at which the project director
can receive e-mail.

2f. **Department** -- Enter the Organizational affiliation, such as
Department of Medicine, Social Service Institute, etc.

2g. **School or College** -- Enter the name of the school, college, or
other major subdivision such as medicine, dental, public health, etc.

2h. **Telephone** - Enter the number at which the project director
usually can be reached during business hours.

2i. **FAX** - Enter the number at which the project director can receive
FAX mail.

3\. **Dates of Entire Proposed Project Period** - The total period of
support is 3 years. Generally, the start date is September 1.

4\. **Applicant Organization** - Name the one institution that will be
legally and financially responsible and accountable for the use and
disposition of any DHHS funds awarded on the basis of this application.
Enter name and address (street, city, state, [nine-digit zip
code]{.underline}).

5\. **Congressional District of Applicant** - Enter the Congressional
District in which the applicant institution is located.

5a. **Other Districts that Benefit Financially from this Grant** - Enter
the other Congressional District(s) that may benefit financially if an
award is made.

6\. **Official in Business Office to be Contacted Concerning
Application** - Self-explanatory.

6a. **Single Point of Contact** is a designated institutional official
responsible for all business management activities between the
institution and the Grants Management Office of the Bureau of Health
Professions (BHPr). **Only complete this item if the institution has not
previously designated a point of contact with BHPr.**

6b. **E-Mail Address of Single Point of Contact** - Self-explanatory.

7\. **Entity Identification Number** - Enter the number assigned by DHHS
to each grantee institution for payment and accounting purposes. If a
number has not been assigned, enter institution\'s IRS employer
identification number.

8\. **Official Signing for the Applicant Organization** - See
instruction for item 13.

9\. **Type of Organization** - Some Federal organizations must submit a
document of eligibility with the completed application in accordance
with DHHS Policy.

> A private nonprofit organization must submit proof of its nonprofit
> status if it has not previously done so. If such proof has been
> previously submitted to any component of DHHS, identify the component
> and the date submitted. Acceptable proof to be submitted with the
> completed application may be: (a) a reference to the organization\'s
> listing in the most recent IRS cumulative list of tax exempt
> organizations; or (b) a copy of a currently valid IRS tax exemption
> certificate; or (c) a statement from a State taxing authority or State
> Attorney General, certifying that the organization is a nonprofit
> organization operating within the State and that no part of its
> earnings may lawfully inure to the benefit of any private shareholder
> or individual; or (d) a certified copy of the certificate of
> incorporation or other document which clearly establishes the
> nonprofit status of the organization; or (e) any of the items
> immediately above for a State or national parent organization and a
> statement signed by the parent organization that the applicant
> organization is a local non-profit affiliate.

10\. **Project Director Assurance -** Self-explanatory.

11\. **Signature** - Self-explanatory.

12\. **Certification and Acceptance** - The signature of an authorized
official of the applicant institution is required as certification that
the information in the application is correct, that the institution
agrees to abide by enabling legislation, applicable regulations, DHHS
policies, and conditions placed on the award, and that adequate
facilities will be made available for the conduct of the proposed
project.

13\. **Signature** - Self-explanatory. If the official named in item 8
is not available to sign for the applicant organization, an official
authorized may sign as \"acting\" for such official. \"Per\" signatures
are not acceptable. Signatures are required in ink and on original copy
only.

[]{#refheading___toc83201527 .anchor}*Form 6025-2*

DETAILED BUDGET

**Refer to application instructions for completing the budget. OMB
Approval Number 0915-0060, Expiration Date: 08/31/2006**

+-----------------------------------------------------------------------+
| ####### **A. Non- trainee Expenses**                                  |
+-----------------------------------------------------------------------+

+-------------------+---------+----+-----+-------+-------+-----------+
| ### Name          | ### Tit | *  | **H | ### S | **Fri | #         |
|                   | le of P | *% | our | alary | nge** | ### Total |
|                   | osition | ** | s** |       |       |           |
|                   |         |    |     |       | **    |           |
|                   |         |    | *   |       | Benef |           |
|                   |         |    | *pe |       | its** |           |
|                   |         |    | r** |       |       |           |
|                   |         |    |     |       |       |           |
|                   |         |    | **  |       |       |           |
|                   |         |    | wee |       |       |           |
|                   |         |    | k** |       |       |           |
+-------------------+---------+----+-----+-------+-------+-----------+

  ------------------------------------------ ------- -------- ------------
  Subtotals                                                   

  ------------------------------------------ ------- -------- ------------

**HRSA-6025-2 (Formerly PHS-6025-2) (Revised 6/00) OMB Approval NO.
0915-060** 2006

[]{#__RefHeading___Toc83201533 .anchor}*Form 6025-3*

**CONSOLIDATED BUDGET**

<table>
<colgroup>
<col style="width: 23%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>Direct Costs</strong></td>
<td colspan="5"><p><strong>First Budget Period</strong></p>
<p><strong>FY 2006</strong></p></td>
<td colspan="4"><p><strong>Second Budget Period</strong></p>
<p><strong>FY 2007</strong></p></td>
<td colspan="4"><p><strong>Third Budget Period</strong></p>
<p><strong>FY 2008</strong></p></td>
<td colspan="4"><strong>Total</strong></td>
</tr>
<tr class="even">
<td><strong>Program Area(s)</strong></td>
<td colspan="3"><strong>A*</strong></td>
<td colspan="2"><strong>B*</strong></td>
<td colspan="2"><strong>A*</strong></td>
<td colspan="2"><strong>B*</strong></td>
<td colspan="2"><strong>A*</strong></td>
<td colspan="2"><strong>B*</strong></td>
<td colspan="2"><strong>A*</strong></td>
<td colspan="2"><strong>B*</strong></td>
</tr>
<tr class="odd">
<td><blockquote>
<p><strong>Discipline(s)</strong></p>
</blockquote></td>
<td colspan="2">A1*</td>
<td>A2*</td>
<td>B1*</td>
<td>B2*</td>
<td>A1*</td>
<td>A2*</td>
<td>B1*</td>
<td>B2*</td>
<td>A1*</td>
<td>A2*</td>
<td>B1*</td>
<td>B2*</td>
<td>A1*</td>
<td>A2*</td>
<td>B1*</td>
<td>B2*</td>
</tr>
<tr class="even">
<td><strong>A. Non-Trainee Expenses</strong></td>
<td colspan="17"></td>
</tr>
<tr class="odd">
<td><blockquote>
<p><strong>Personnel</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p><strong>Consultant Costs</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p><strong>Equipment</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p><strong>Contracts</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p><strong>Supplies</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p><strong>Staff Travel</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p><strong>Other Expenses</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>Subtotal Section A</strong></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>B. Trainee Expenses</strong></td>
<td colspan="16"></td>
</tr>
<tr class="even">
<td><blockquote>
<p><strong>Stipends</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p><strong>Tuition &amp; Fees</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p><strong>Trainee Travel</strong></p>
</blockquote></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>Subtotal Section B</strong></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>Total Direct Costs (Add Subtotals of Sections A &amp;
B)</strong></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**Indirect Cost Requested? [\_\_\_]{.underline}Yes
[\_\_\_]{.underline}No If \"Yes,\" at [\_\_\_]{.underline}% rate.**

**[NOTE:]{.underline} Replace A\* and B\* with involved program area(s)
and replace A1\*, A2\*, B1\*, and B2\* with the involved discipline(s).
If more than 2 disciplines are involved in one program area in a
combined application, the applicant may add another column as
appropriate. If more program areas are involved, more columns may be
added, or the table may be duplicated.**

HRSA-6025-3 Page 1 (Formerly PHS-6025-3; Revised 06/200) **OMB Approval
NO. 0915-0060**

**CONSOLIDATED BUDGET (Cont.)**

<table>
<colgroup>
<col style="width: 23%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>C. Estimated Funding</strong></td>
<td colspan="4"><p><strong>First Budget Period</strong></p>
<p><strong>FY 2006</strong></p></td>
<td colspan="4"><p><strong>Second Budget Period</strong></p>
<p><strong>FY 2007</strong></p></td>
<td colspan="4"><p><strong>Third Budget Period</strong></p>
<p><strong>FY 2008</strong></p></td>
<td colspan="4"><strong>Total</strong></td>
</tr>
<tr class="even">
<td><strong>Program Area(s)</strong></td>
<td colspan="2"><strong>A*</strong></td>
<td colspan="2"><strong>B*</strong></td>
<td colspan="2"><strong>A*</strong></td>
<td colspan="2"><strong>B*</strong></td>
<td colspan="2"><strong>A*</strong></td>
<td colspan="2"><strong>B*</strong></td>
<td colspan="2"><strong>A*</strong></td>
<td colspan="2"><strong>B*</strong></td>
</tr>
<tr class="odd">
<td><strong>Discipline(s)</strong></td>
<td>A1*</td>
<td>A2*</td>
<td>B1*</td>
<td>B2*</td>
<td>A1*</td>
<td>A2*</td>
<td>B1*</td>
<td>B2*</td>
<td>A1*</td>
<td>A2*</td>
<td>B1*</td>
<td>B2*</td>
<td>A1*</td>
<td>A2*</td>
<td>B1*</td>
<td>B2*</td>
</tr>
<tr class="even">
<td><strong>Federal (Requested in this Application)</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>Other Federal</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>Applicant Institution</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>State, Local/Other</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>Program Income</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>Total</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**[NOTE:]{.underline} Replace A\* and B\* with involved program area(s)
and replace A1\*, A2\*, B1\*, and B2\* with the involved discipline(s).
If more than 2 disciplines are involved in one program area in a
combined application, the applicant may add another column as
appropriate. If more program areas are involved, more columns may be
added, or the table may be duplicated.**

HRSA-6025-3 Page 2 (Formerly PHS-6025-3)

(Revised 06/2000)

[]{#__RefHeading___Toc83201536 .anchor}COE Suggested Template A

**APPLICATION TABLE OF CONTENTS**

**The applicant should use the following outline upon completion of the
application materials for submission.**

**Section Page Number**

**I. [Face Page]{.underline}**

**II. [Table of Contents ]{.underline}**

**III. [Application Checklist]{.underline}**

**IV. [Summary of Project]{.underline}**

**V. [Budget]{.underline}**

-   **Detailed**

-   **Consolidated**

**VI. [Budget Justification]{.underline}**

**VII. [Staffing Plan & Personnel Requirements]{.underline}**

**VIII. [Assurances]{.underline}**

**IX. [Certifications and Other Program Requirements]{.underline}**

**X. [Project Abstract]{.underline}**

**XI. [Program Narrative]{.underline}**

-   **Introduction**

-   **Institutional Commitment**

-   **Needs Assessment**

-   **Cultural Competence Development**

-   **Methodology, Workplan & Evaluation**

-   **Progress Report**

**XII. [Appendices]{.underline}**

-   **HRSA Training Grant Application Forms**

-   **COE Suggested Templates**

> **- General Conditions Guidelines -- COE Suggested Template I**
>
> **- Enrollment Tables -- COE Suggested Template G**
>
> **- Maintenance of Effort Table -- COE Suggested Template D**
>
> **- COE Purpose Reference Table -- COE Suggested Template F**
>
> **- Biographical Sketch -- COE Suggested Template C**
>
> **- Student Training in Health Care Services -- COE Suggested Template
> H**

## COE Suggested Template B

## CHECKLIST

**This is the required last page of the application.**

**(Check the appropriate boxes and provide the information requested.)**

**TYPE OF APPLICATION**

**\_\_\_\_\_\_ New application (This application is being submitted to
DHHS for a project or program not currently receiving support.)**

**\_\_\_\_\_\_ Competing Continuation of grant number:**

> **(This application is to extend for one or more additional budget
> periods a project period that would otherwise expire.)**

**ASSURANCES, CERTIFICATIONS AND OTHER REQUIREMENTS**

**Please see the instructions for Assurances, Certifications and Other
Requirements. If the necessary forms have been filed, assurances and
certification made, and other requirements met, please check \"yes\"
below. If \"no\" is checked, please explain. Please see following page
for assurances, certifications and other requirement.**

**\_\_\_\_\_\_\_ Yes**

**\_\_\_\_\_\_\_ No (If \"No,\" provide explanation.)**

**DATA UNIVERSAL NUMBERING SYSTEM (DUNS)**

**\_\_\_\_\_\_\_ DUNS number has been completed on the face page**

***Assurances**:*

Please check \"Yes\" on the Checklist (COE Suggested Template B, page
47) if all conditions are met. If one or more of the following
assurances, certifications, and other requirements are not met, check
"No" and explain.

> **1.** **Civil Rights**: Before an award is made, the applicant
> organization must have submitted, and had accepted by the DHHS Office
> for Civil Rights, an Assurance of Compliance Form DHHS 690 in
> accordance with Title VI of the Civil Rights Act of 1964, P.L. 88-352.
> Pertinent DHHS regulations are found in 45 CFR Part 80. This provides
> that no person in the United States shall on the grounds of race,
> color, or national origin be excluded from participation in, be denied
> the benefits of, or be otherwise subjected to discrimination under any
> program or activity receiving Federal financial assistance from DHHS.
>
> **2. Handicapped Individuals:** Before an award is made, the applicant
> organization must have submitted, and had accepted by the DHHS Office
> for Civil Rights, an Assurance of Compliance Form HHS 690, in
> accordance with Sec. 504 of the Rehabilitation Act of 1973, P.L.
> 93-112, as amended (29 USC 794).
>
> This provides that no handicapped individual shall, solely by reason
> of the handicap, be excluded from participation in, be denied the
> benefits of, or be subjected to discrimination under any program or
> activity receiving Federal financial assistance. Pertinent DHHS
> regulations are found in 45 CFR Part 84.

**3. Age Discrimination**: In accordance with Title III of the Age
Discrimination Act of 1975, as amended, P.L. 94-135, 45 CFR Part 91,
attention is called to the general rule that no person in the United
States shall, on the basis of age, be excluded from participation in, be
denied the benefit of, or be subjected to discrimination under any
program or activity receiving Federal financial assistance. The required
assurance (Form HHS-690) must be on file with the Office for Civil
Rights, Office of the Secretary, HHS, before a grant may be made.

**4. Sex Discrimination**: Before an award is made, the applicant
educational organization must have submitted and had accepted by the
DHHS Office for Civil Rights an Assurance of Compliance Form HHS 690 in
accordance with Sec. 901 of Title IX of the Education Amendments of
1972, P.L. 92-318, as amended, which provides that no person shall, on
the basis of sex, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any education
program or activity receiving Federal financial assistance. Pertinent
DHHS regulations are found in 45 CFR Part 86.

> Specific provisions in Titles VII and VIII of the PHS Act (currently
> numbered Secs. 794 and 810) prohibit the Secretary, DHHS, from making
> any grant, contract, loan guarantee, or interest subsidy payment under
> Title VII or VIII to an entity which does not furnish assurances
> satisfactory to the Secretary that the entity will not discriminate on
> the basis of sex in the admission of individuals to its training
> programs.
>
> In accordance with 45 CFR Part 83 of DHHS regulations, no grant,
> contract, loan guarantee or interest subsidy payment under Titles VII
> and VIII of the PHS Act shall be made to or for the benefit of any
> entity unless the entity furnishes assurances satisfactory to the
> Director, Office for Civil Rights, that the entity will not
> discriminate on the basis of sex in the admission of individuals to
> its training programs.

5.  **Other Discrimination**: Attention is called to the requirements of
    Sec. 401 of the Health Programs Extension Act of 1973, P.L. 93-45,
    as amended (42 USC 300a-7), which provides that no entity that
    receives any grant, contract, loan, loan guarantee, or interest
    subsidy under the PHS Act may deny admission or otherwise
    discriminate against any applicant (including applicants for
    internships and residencies) for training or study because of the
    applicant's reluctance or willingness to counsel, suggest,
    recommend, assist, or in any way participate in the performance of
    abortions or sterilizations contrary to, or consistent with, the
    applicant's religious beliefs or moral convictions.

[]{#__RefHeading___Toc83201481 .anchor}*Certifications and Other
Requirements*

> Please check \"Yes\" on the Checklist (COE Suggested Template B, page
> 47) if all conditions are met. If one or more of the following
> assurances, certifications, and other requirements are not met, check
> "No" and explain.

1.  **Drug Free Workplace Act of 1988, Title V, Subtitle D of P.L.
    100-690**: The applicant institution must comply with the
    requirements of 45 CFR Part 82, which require certification that
    grantees will provide and maintain a drug-free workplace.

> **2. Certification Regarding Lobbying and Disclosure of Lobbying
> Activities**: Each person shall file a certification and a disclosure
> form, if required, with each submission that initiates agency
> consideration of such person for award of a Federal contract, grant,
> loan, or cooperative agreement award action exceeding \$100,000.
> Government-wide guidance for restrictions on lobbying was published by
> the Office of Management and Budget in the *Federal Register*, 54 FR
> 52306, December 20, 1989. Pertinent DHHS regulations are found in 45
> CFR Part 93. See also authority under Sec. 319, P.L. 101-121, as
> amended (31 USC 1352).
>
> **3. Misconduct in Science**: Each institution that applies for or
> receives assistance under a research, research-training, or
> research-related grant or cooperative agreement under the PHS Act must
> submit an annual assurance (Form PHS 6349) certifying that the
> institution has established administrative policies as required by the
> Final Rule (42 CFR Part 50, Subpart A) and that it will comply with
> those policies and requirements of the Final Rule as published in the
> *Federal Register* at 54 FR 32449, August 8, 1989.
>
> As of January 1, 1990, Notice of Grant awards for grants and
> cooperative agreements involving research may be issued only to
> institutions that have filed with the Office of Research Integrity
> (ORI), acceptable assurances for dealing with and reporting possible
> misconduct in science. The respective Grants Management Offices will
> determine the status of an institution by contacting ORI.
>
> **4. Debarment and Suspension**: The applicant organization must
> certify, among other things, that neither it nor its principals are
> presently debarred, suspended, proposed for debarment, declared
> ineligible, or voluntarily excluded from covered transactions by any
> Federal department or agency. Sub-awardees that is, other
> corporations, partnerships, or other legal entities (called "lower
> tier" participants), must make the same certification to the applicant
> organization concerning their covered transactions. Pertinent DHHS
> regulations are found in 45 CFR Part 76 and refer to Executive Order
> 12549 which provides that, to the extent permitted by law, executive
> departments and agencies shall participate in a government-wide system
> for non-procurement debarment and suspension.

5.  **Statement of Non-Delinquency on Federal Debt**: This question
    applies only to the person or institution requesting financial
    assistance and does not apply to the person who signs an application
    form as the authorized representative of an institution or on behalf
    of another person who actually receives the funds.

> Examples of Federal Debt include delinquent taxes, audit
> disallowances, guaranteed or direct student loans, FHA loans, and
> other miscellaneous administrative debts. For purposes of this
> statement, the following definitions apply:

-   For direct loans, a debt more than 31 days past due on a scheduled
    payment.

-   For agents, recipients of a "Notice of Grants Cost Disallowance" who
    have not repaid the disallowed amount or who have not resolved the
    disallowance.

-   For guaranteed and insured loans, recipients of a loan guaranteed by
    the Federal Government that the Federal Government has repurchased
    from a lender because the borrower breached the loan agreement and
    is in default.

6.  **Drug-Free Schools and Campuses**: The Drug-Free Schools and
    Communities Act Amendments of 1989, P.L. 101-226, Sec. 22, which
    added Sec. 1213 to the Higher Education Act, require that any public
    or private institution of higher education (including independent
    hospitals conducting training programs for health care personnel),
    State educational agency, or local educational agency receiving
    Federal financial assistance to certify to the Secretary of
    Education, as a condition for funding, that it has adopted and
    implemented a drug prevention program as described in regulations at
    34 CFR Part 86. The provisions of the regulations also apply to sub
    grantees that receive Federal funds from any Federal grantee
    regardless of whether or not the primary grantee is an institution
    of higher education, State educational agency, or local educational
    agency.

> **7. Bloodborne Diseases:** Sec. 308 of Title III of P.L. 102-408, the
> Health Professions Education Extension Amendments of 1992, requires
> that with respect to awards of grants or contracts under Title VII or
> VIII of the PHS Act, the Secretary of HHS may make such an award for
> the provision of traineeships only if the applicant for the award
> provides assurances satisfactory to the Secretary that all trainees
> will, as appropriate, receive instruction in the utilization of
> universal precautions and infection control procedures for the
> prevention of the transmission of bloodborne diseases.

**8. Smoke-Free Workplace**: The Public Health Service strongly
encourages all grant and cooperative agreement recipients to provide a
smoke-free workplace and promote the nonuse of all tobacco products.
Title X, Part C of P.L. 103-227, the Pro-Children Act of 1994, prohibits
smoking in certain facilities that receive Federal funds in which
education, library, day care, health care, and early childhood
development services are provided to children.

**COE Suggested Template C**

##### BIOGRAPHICAL SKETCH

**Name: (Last, first, middle initial)**

**Title:**

**Education:**

+--------------------------------+-----------+-----------+------------+
| **Institution and Location**   | ###       | **Year**  | ######     |
|                                | ## Degree |           |   Field of |
|                                |           | **Co      |            |
|                                |           | nferred** | **Study**  |
+--------------------------------+-----------+-----------+------------+
|                                |           |           |            |
+--------------------------------+-----------+-----------+------------+

**Professional Experience:**

**COE Suggested Template D**

***MAINTENANCE OF EFFORT TABLE***

**NON-FEDERAL EXPENDITURES**

+-----------------------------------+----------------------------------+
| **FY 2005 (Actual)**              | **FY 2006 (Estimated)**          |
|                                   |                                  |
| Actual FY 2004 non-Federal funds, | Estimated FY 2005 non-Federal    |
| including in-kind, expended for   | funds, including in-kind,        |
| activities proposed in this       | designated for activities        |
| application. If proposed          | proposed in this application.    |
| activities are not currently      |                                  |
| funded by the institution, enter  | **Amount:                        |
| \$0.                              | [\$\_\_\_\_\_\_\_\_\             |
|                                   | _\_\_\_\_\_\_\_\_]{.underline}** |
| **Amount:                         |                                  |
| [\$\_\_\_\_\_\_                   |                                  |
| \_\_\_\_\_\_\_\_\_]{.underline}** |                                  |
+-----------------------------------+----------------------------------+

## 

**COE Suggested Template E**

##### SUMMARY OF PROJECT

**(Limit to 3 pages)**

**Project Title:**

**COE Designation: See Designation of Centers of Excellence**

**Organization Name:**

**Address:**

**Project Director: Telephone:**

**E-mail: Fax :**

**Project Period:**

**I.** [**PURPOSE AND PROGRAM CHARACTERISTICS**]{.underline}

[Summarize]{.underline} the following:

-   **Introduction**

-   **Institutional Commitment**

-   **Needs Assessment**

-   **Cultural Competence Development**

-   **Methodology, Workplan & Evaluation**

-   **Progress Report**

**COE Suggested Template F**

> **COE PURPOSE REFERENCE TABLE**
>
> Using the table below, identify which objective and/or grant related
> activity addresses each of the corresponding COE Legislative
> Requirements and Review Criteria and the page where it can be found**.
> The size of the chart may be altered.**

+-----------------------+-----------------------+-----------------------+
| **COE Review          | **Related             | **Page Reference**    |
| Criteria**            | Objective(s) or       |                       |
|                       | Activity**            |                       |
+-----------------------+-----------------------+-----------------------+
| NEEDS ASSESSMENT      |                       |                       |
+-----------------------+-----------------------+-----------------------+
| RESOURCES/            |                       |                       |
| CAPABILITIES/IMPACT   |                       |                       |
|                       |                       |                       |
| -   Institutional     |                       |                       |
|     Commitment        |                       |                       |
+-----------------------+-----------------------+-----------------------+
| RESPONSE              |                       |                       |
|                       |                       |                       |
| -   Student           |                       |                       |
|     Performance       |                       |                       |
|                       |                       |                       |
| -   Faculty           |                       |                       |
|     Development       |                       |                       |
|                       |                       |                       |
| ```{=html}            |                       |                       |
| <!-- -->              |                       |                       |
| ```                   |                       |                       |
| -   Information       |                       |                       |
|     Resources,        |                       |                       |
|     Clinical          |                       |                       |
|     Education,        |                       |                       |
|     Curricula         |                       |                       |
|                       |                       |                       |
| -   Competitive       |                       |                       |
|     Applicant Pool    |                       |                       |
|                       |                       |                       |
| -   Faculty and       |                       |                       |
|     Student Research  |                       |                       |
|                       |                       |                       |
| -   Student Training  |                       |                       |
|     in Providing      |                       |                       |
|     Health Care       |                       |                       |
|     Services          |                       |                       |
+-----------------------+-----------------------+-----------------------+
| CULTURAL COMPETENCE   |                       |                       |
|                       |                       |                       |
| DEVELOPMENT           |                       |                       |
+-----------------------+-----------------------+-----------------------+
| EVALUATIVE MEASURES   |                       |                       |
|                       |                       |                       |
| -   Progress Report   |                       |                       |
|     Summary           |                       |                       |
+-----------------------+-----------------------+-----------------------+
| SUPPORT REQUESTED     |                       |                       |
|                       |                       |                       |
| -   Budget            |                       |                       |
+-----------------------+-----------------------+-----------------------+

**OMB Approval NO. 0915-0060**

**COE Suggested Template G**

**Enrollment Tables**

**Institution:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**TABLE I: Number and Percent Distribution of First-Year Enrollment of
URM**

**Students by Race/Ethnicity & Academic Year**

+--------------------+----+-----+----+-----+----+-----+----+-----+
|                    | *  |     |    |     |    |     |    |     |
|                    | *F |     |    |     |    |     |    |     |
|                    | IR |     |    |     |    |     |    |     |
|                    | ST |     |    |     |    |     |    |     |
|                    | YE |     |    |     |    |     |    |     |
|                    | AR |     |    |     |    |     |    |     |
|                    | EN |     |    |     |    |     |    |     |
|                    | RO |     |    |     |    |     |    |     |
|                    | LL |     |    |     |    |     |    |     |
|                    | ME |     |    |     |    |     |    |     |
|                    | NT |     |    |     |    |     |    |     |
|                    | A  |     |    |     |    |     |    |     |
|                    | ND |     |    |     |    |     |    |     |
|                    | P  |     |    |     |    |     |    |     |
|                    | ER |     |    |     |    |     |    |     |
|                    | CE |     |    |     |    |     |    |     |
|                    | NT |     |    |     |    |     |    |     |
|                    | ** |     |    |     |    |     |    |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **RACE/ETHNICITY** | *  |     | *  |     | *  |     | *  |     |
|                    | *2 |     | *2 |     | *2 |     | *2 |     |
|                    | 00 |     | 00 |     | 00 |     | 00 |     |
|                    | 2- |     | 3- |     | 4- |     | 5- |     |
|                    | 03 |     | 04 |     | 05 |     | 06 |     |
|                    | ** |     | ** |     | ** |     | ** |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
|                    | *  | **  | *  | **  | *  | **  | *  | **  |
|                    | *N | %** | *N | %** | *N | %** | *N | %** |
|                    | o. |     | o. |     | o. |     | o. |     |
|                    | ** |     | ** |     | ** |     | ** |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **Black or African |    |     |    |     |    |     |    |     |
| American**         |    |     |    |     |    |     |    |     |
|                    |    |     |    |     |    |     |    |     |
| **(Non Hispanic)** |    |     |    |     |    |     |    |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **Hispanic or      |    |     |    |     |    |     |    |     |
| Latino**           |    |     |    |     |    |     |    |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **American Indian  |    |     |    |     |    |     |    |     |
| , Alaska Native**  |    |     |    |     |    |     |    |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **Native Hawaiian  |    |     |    |     |    |     |    |     |
| or Other Pacific   |    |     |    |     |    |     |    |     |
| Islander**         |    |     |    |     |    |     |    |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **Asian,           |    |     |    |     |    |     |    |     |
| U                  |    |     |    |     |    |     |    |     |
| nder-represented** |    |     |    |     |    |     |    |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **Total URM        |    |     |    |     |    |     |    |     |
| Students**         |    |     |    |     |    |     |    |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **Total            |    |     |    |     |    |     |    |     |
| Non                |    |     |    |     |    |     |    |     |
| -Under-represented |    |     |    |     |    |     |    |     |
| Students**         |    |     |    |     |    |     |    |     |
|                    |    |     |    |     |    |     |    |     |
| **\[White (Non     |    |     |    |     |    |     |    |     |
| Hispanic); Asian,  |    |     |    |     |    |     |    |     |
| Non-Und            |    |     |    |     |    |     |    |     |
| er-represented\]** |    |     |    |     |    |     |    |     |
+--------------------+----+-----+----+-----+----+-----+----+-----+
| **Total First Year |    | **  |    | **  |    | **  |    | **  |
| Students**         |    | 100 |    | 100 |    | 100 |    | 100 |
|                    |    | %** |    | %** |    | %** |    | %** |
+--------------------+----+-----+----+-----+----+-----+----+-----+

**Note: Any clarifications on data in Table I should be provided
immediately following the table.**

**TABLE II: Number and Percent Distribution of Total School Enrollment
of URM**

**Students by Race/Ethnicity & Academic Year**

+--------------------------+----+------+----+----+----+---+----+---+
|                          | *  |      |    |    |    |   |    |   |
|                          | *T |      |    |    |    |   |    |   |
|                          | OT |      |    |    |    |   |    |   |
|                          | AL |      |    |    |    |   |    |   |
|                          | SC |      |    |    |    |   |    |   |
|                          | HO |      |    |    |    |   |    |   |
|                          | OL |      |    |    |    |   |    |   |
|                          | EN |      |    |    |    |   |    |   |
|                          | RO |      |    |    |    |   |    |   |
|                          | LL |      |    |    |    |   |    |   |
|                          | ME |      |    |    |    |   |    |   |
|                          | NT |      |    |    |    |   |    |   |
|                          | A  |      |    |    |    |   |    |   |
|                          | ND |      |    |    |    |   |    |   |
|                          | P  |      |    |    |    |   |    |   |
|                          | ER |      |    |    |    |   |    |   |
|                          | CE |      |    |    |    |   |    |   |
|                          | NT |      |    |    |    |   |    |   |
|                          | ** |      |    |    |    |   |    |   |
+--------------------------+----+------+----+----+----+---+----+---+
| **RACE/ETHNICITY**       | *  |      | *  |    | *  |   | *  |   |
|                          | *2 |      | *2 |    | *2 |   | *2 |   |
|                          | 00 |      | 00 |    | 00 |   | 00 |   |
|                          | 2- |      | 3- |    | 4- |   | 5- |   |
|                          | 03 |      | 04 |    | 05 |   | 06 |   |
|                          | ** |      | ** |    | ** |   | ** |   |
+--------------------------+----+------+----+----+----+---+----+---+
|                          | *  | *    | *  | *  | *  | * | *  | * |
|                          | *N | *%** | *N | *% | *N | * | *N | * |
|                          | o. |      | o. | ** | o. | % | o. | % |
|                          | ** |      | ** |    | ** | * | ** | * |
|                          |    |      |    |    |    | * |    | * |
+--------------------------+----+------+----+----+----+---+----+---+
| **Black or African       |    |      |    |    |    |   |    |   |
| American**               |    |      |    |    |    |   |    |   |
|                          |    |      |    |    |    |   |    |   |
| **(Non-Hispanic)**       |    |      |    |    |    |   |    |   |
+--------------------------+----+------+----+----+----+---+----+---+
| **Hispanic or Latino**   |    |      |    |    |    |   |    |   |
+--------------------------+----+------+----+----+----+---+----+---+
| **American Indian,       |    |      |    |    |    |   |    |   |
| Alaska Native**          |    |      |    |    |    |   |    |   |
+--------------------------+----+------+----+----+----+---+----+---+
| **Native Hawaiian, Other |    |      |    |    |    |   |    |   |
| Pacific Islander**       |    |      |    |    |    |   |    |   |
+--------------------------+----+------+----+----+----+---+----+---+
| **Asian,                 |    |      |    |    |    |   |    |   |
| Under-represented**      |    |      |    |    |    |   |    |   |
+--------------------------+----+------+----+----+----+---+----+---+
| **Total URM Students**   |    |      |    |    |    |   |    |   |
+--------------------------+----+------+----+----+----+---+----+---+
| **Total                  |    |      |    |    |    |   |    |   |
| Non-Under-represented    |    |      |    |    |    |   |    |   |
| Students**               |    |      |    |    |    |   |    |   |
|                          |    |      |    |    |    |   |    |   |
| **\[White (Non           |    |      |    |    |    |   |    |   |
| Hispanic); Asian,        |    |      |    |    |    |   |    |   |
| N                        |    |      |    |    |    |   |    |   |
| on-Under-represented\]** |    |      |    |    |    |   |    |   |
+--------------------------+----+------+----+----+----+---+----+---+
| **Total Students         |    | **10 |    | ** |    | * |    | * |
| Enrolled**               |    | 0%** |    | 10 |    | * |    | * |
|                          |    |      |    | 0% |    | 1 |    | 1 |
|                          |    |      |    | ** |    | 0 |    | 0 |
|                          |    |      |    |    |    | 0 |    | 0 |
|                          |    |      |    |    |    | % |    | % |
|                          |    |      |    |    |    | * |    | * |
|                          |    |      |    |    |    | * |    | * |
+--------------------------+----+------+----+----+----+---+----+---+

**Note: Any clarifications on data in Table II should be provided
immediately following the table.**

**COE Suggested Template H**

## STUDENT TRAINING IN HEALTH CARE SERVICES (Renewals Only)

**How many COE Students participated in Health Services Training at
sites located in Community Based Health Facilities in the [past 3
years]{.underline}? Identify if it is a Health Professional Shortage
Area (HPSA) with an asterisk (\*). Please fill in the number of
students, the name and location of the training site and the average
number of days per student.**

  ---------------- ----------------------------- ------------------------
  Number of        Name/Location of Training     Average \# of days per
  Students         Site                          student

                                                 

                                                 

                                                 

                                                 
  ---------------- ----------------------------- ------------------------

**COE Suggested Template I**

###### General Condition Guidelines

**Name of School:** **Eligible Discipline:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Section I - Health Profession School Type "COE Designation"**

> Total School Enrollment for COE Category:
>
> (Enter only the total School Enrollment in Whole Numbers for your COE
> Category, with the exception of "Other URM" category; please enter
> percentage for Total School Enrollment

**(Enter only the total School Enrollment Numbers for your COE
Category)**

**HBCU HSI NA OTHER URM**

**Qualifier: Should meet the school enrollment number requirements for
COE Category and Discipline**

**Section II - Number of URM Graduates**

1\. Total #URMs in Entering Class 2001\_\_\_\_\_\_ (Whole #) or
2002\_\_\_\_\_\_(Whole #)

2\. Total \# URMs from line 1 graduating by Academic Year 2006\_\_\_\_
(Whole Number)

3\. URM graduation rate for 20056\_\_\_\_\_ (will be a 4 or 5 year rate
depending on the year of the entering class specified above)

**Qualifier: Applicant should have a URM graduation rate of at least 85%
over 4 or 5 years. For Native American COEs Only: Applicant should have
a URM graduation rate of at least 75%.**

**Section III- Scholarships/Financial Assistance**

Total \# URM in Designated School \_\_\_\_\_\_\_\_\_\_\_\_

Total \# URM with Self-Pay (ONLY) \_\_\_\_\_\_\_\_\_\_\_\_

Total \# URM Receiving Financial Assistance\* (ONLY)
\_\_\_\_\_\_\_\_\_\_\_\_

Total \# URM with Self-Pay [and]{.underline} Financial Assistance\*
\_\_\_\_\_\_\_\_\_\_**\_\_**

**\* Financial Assistance includes scholarships, grants, tuition
waivers, student loans, etc., which have been obtained from any source**

**Additional Data:**

**Using the [total number]{.underline} of URM students listed above,
determine what percentage of their professional education costs are
from:**

**Self-Pay \_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Scholarships / Grants \_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Tuition Waivers / etc. \_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Student Loans \_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Qualifier: Applicant should have 100% of their URM students receiving
some type of financial assistance.**

**COE Suggested Template I (cont'd)**

**Section IV- URM Full and Part-time Faculty and Administrative
Positions**

**[ACADEMIC YEAR \| 2002 \| 2003 \| 2004 \| 2005 \| 2006
\|]{.underline}**

**Total \# of Faculty\***

**Total \# of URM Faculty\***

**Percent of URM Faculty**

**Total \# of Vacancies\*
====================================================================**

**Total \# of Admin. Positions \*\***

**Total \# of URM Admin. Positions\*\***

**Percent of URM Admin. Positions**

**Total \# of Admin. Positions**

**Vacancies**

**\*Part-time does NOT include Adjunct Faculty**

**\*\*See Definition Section**

Briefly explain Applicant's significant effort to recruit and retain URM
Faculty and

Administrative Positions:

**Qualifier: Description of policies and/or activities showing how the
Institution has made significant recruitment efforts to increase the
number of under-represented minority individuals serving in faculty or
administrative positions.**