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

**Health Resources and Services Administration**

Bureau of Health Professions

Division of Nursing

**Title VIII**

**Nursing Workforce Diversity (NWD) Grant Program**

**New and Competing Continuation Competition**

**Announcement Number HRSA-06-035**

**Catalog of Federal Domestic Assistance (CFDA) No. 93.178**

**PROGRAM GUIDANCE**

**New and Competing Continuations**

Fiscal Year 2006 []{.mark}

**Application Due Date: January 12, 2006**

**Release Date: *November 28, 2005 ***

**Date of Issuance: November 28*, 2005***

Janice B. Young, Ph.D., MPH, RN

Lead Nurse Consultant, BHPr, Division of Nursing

Telephone: (301) 443-6193

Fax: (301) 443-0791

Authority: Public Health Service Act, Title VIII, Section 821, as
amended; Nurse Education and Practice Improvement Act of 1998, Public
Law 107-205;42 U.S.C. 296p

**EXECUTIVE SUMMARY**

The purpose of the **Nursing Workforce Diversity (NWD)** grant program
is to provide Federal funding for projects to increase nursing education
opportunities for individuals from disadvantaged backgrounds (including
racial and ethnic minorities underrepresented among registered nurses).
The Nursing Workforce Diversity program supports projects focused on
creating registered nurses. Applications for projects supporting a
terminal education level other than registered nurse will not be
eligible for funding.

The program has three major purposes that applicants must address: **1)
retention activities, 2) pre-entry preparation, and 3) student
scholarships and/or stipends.**

Expected outcomes include increasing nursing education opportunities for
individuals from disadvantaged backgrounds in order to increase nursing
workforce diversity. Eligible entities are: schools of nursing, nursing
centers, academic health centers, State or local governments, Indian
Tribe or Tribal organizations, other public or private non-profit
entities including faith-based and community organizations, and
for-profit entities capable of carrying out the legislative purpose.
Final review criteria can be seen in the corresponding section of this
application guidance. It is estimated that for FY 2006, 35 new
competitive awards will be funded at approximately \$ 291,000 per grant.
This number reflects the average award amount for the first year of a
three-year award. The application due date is January 12, 2006. The
project period is July 1, 2006 through June 30, 2009.

**Application Guidance Table of Contents**

[i. Funding Opportunity Description 2](#__RefHeading___Toc47265096)

[*Purpose 2*](#__RefHeading___Toc47265097)

[*Background*](#__RefHeading___Toc47265098) *5*

[II. Award Information 2](#__RefHeading___Toc47265100)

*Type of Award 6*

[*Summary of Funding 2*](#__RefHeading___Toc47265102)

[III. Eligibility Information 2](#__RefHeading___Toc47265103)

[*1. Eligible Applicants 2*](#__RefHeading___Toc47265104)

[*2. Cost Sharing/Matching 2*](#__RefHeading___Toc47265106)

*3. Other [6](#__RefHeading___Toc47265108)*

[IV. Application and Submission Information
2](#__RefHeading___Toc47265110)

*V.* [Application Format Requirements](#__RefHeading___Toc47265116) 7

*1. Application Format Requirements 7*

*2**.*** [*Application Format 2*](#__RefHeading___Toc47265117)

**I Application Face page** **8**

**[II.](#__RefHeading___Toc47265119) Table of Contents 9**

[**III.**](#__RefHeading___Toc47265120) **Application Check list** **9**

**[IV.](#refheading___toc47265121) Budget 9**

**[V.](#__RefHeading___Toc47265122) Budget Justification 9**

**[VI.](#__RefHeading___Toc47265123) Staffing Plan and personnel
requirements 12**

**[VII. Assurances](#refheading___toc47265124) 12**

**[VIII.](#__RefHeading___Toc47265125) certifications 12**

**[IX. project](#__RefHeading___Toc47265126) abstract 13**

**[X.](#__RefHeading___Toc47265128) program narrative 13**

**[XI.](#__RefHeading___Toc47265129) Program Specific Forms** **20**

**[XII.](#__RefHeading___Toc47265130) appendices 20**

[*3. Submission Dates and Times 2*](#__RefHeading___Toc47265131)

*[4. Intergovernmental Review 2](#__RefHeading___Toc47265137)1*

[*5. Funding Restrictions 2*](#__RefHeading___Toc47265139)

[*6. Other Submission Requirements 2*](#__RefHeading___Toc47265140)

[V. Application Review Information 2](#__RefHeading___Toc47265142)

[*1. Review Criteria 2*](#Review_ReviewCriteria)

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

[*3. Anticipated Announcement and Award Dates
2*](#__RefHeading___Toc47265150)

[VI. Award Administration Information 2](#__RefHeading___Toc47265153)

[*1. Award Notices 2*](#__RefHeading___Toc47265154)

[*2. Administrative and National Policy Requirements
2*](#__RefHeading___Toc47265156)

[*3. Reporting 2*](#__RefHeading___Toc47265158)

*4. Performance Review*

[VII. Agency Contacts 2](#__RefHeading___Toc47265160)

[VII](#__RefHeading___Toc47265164)[i. Tips for Writing a Strong
Application 2](#__RefHeading___Toc47265165)9

**X. *APPLICATION GUIDANCE APPENDIX...
.................................................29***

[]{#__RefHeading___Toc47265096 .anchor}

I. **Funding Opportunity Description**

[]{#__RefHeading___Toc47265097 .anchor}**Purpose**

> This program is authorized under Title VIII, Section 821 of Public
> Health Service Act, as amended by the Nurse Education and Practice
> Improvement Act of 1998, Public Law 107-205;42 U.S.C. 296p. This
> announcement solicits applications for the Nursing Workforce Diversity
> Program. Grants are awarded to eligible institutions for projects to
> increase nursing education opportunities for individuals from
> disadvantaged backgrounds (including racial and ethnic minorities
> underrepresented among registered nurses) for retention activities,
> pre-entry preparation, and student scholarships and/or stipends.
> Applicants are required to address all three activities (retention,
> pre-entry preparation, student stipends/scholarships).
>
> **Background**
>
> The mission of the Health Resources and Services Administration's
> (HRSA's) Bureau of Health Professions (BHPr) is to improve the health
> status of the population by providing national leadership and
> resources to develop, distribute, and retain a diverse, culturally
> competent health workforce that provides the highest quality health
> care for all, especially the underserved. To accomplish this mission,
> BHPr's programs assist with getting the right people, with the right
> skills, in the right places, to achieve the right health outcomes. In
> support of this mission, BHPr goals provide the overall framework for
> all Bureau programs. The goals are:
>
> **Goal 1**: Eliminate Health Barriers: Assure the appropriate supply,
> diversity, composition and distribution of the health professions
> workforce.
>
> **Goal 2**: Eliminate Health Disparities: Assure the availability of a
> full range of healthcare skills and services to populations bearing a
> disproportionate share of disease and disability.
>
> **Goal 3**: Assure Quality of Care: Improve the knowledge, skills,
> competencies and outcomes of health professions workforce.
>
> **Goal 4**: Improve Public Health and Health Care Systems: Assure the
> infrastructure to support an efficient and effective health
> professions workforce.
>
> Under the Nursing Workforce Diversity Program, the funded applicant
> will be required to provide baseline and yearly data on BHPr goals and
> their corresponding outcome(s). Specific guidance on these
> requirements is included under the instructions for the "Objectives"
> and "Evaluation" sections included in the application guidance.

[]{#__RefHeading___Toc47265100 .anchor}**II. Award Information**

**Type of Award**

> Funding will be provided in the form of a new or competing
> continuation three-year grant. **Effective FY 2006, all competing
> continuations approved for funding will be awarded for a period of
> three years.**
>
> **Competing Continuation Awards**
>
> Competing continuation applications may be submitted for continuance
> of a grant beyond the initial project period. A competing continuation
> application is usually submitted during the beginning of the third
> year of the initial project period. The submission date is the same
> for new applications and competing continuation applications. These
> applications are reviewed in the same manner and at the same time as
> new competing applications.

[]{#__RefHeading___Toc47265102 .anchor}**Summary of Funding**

> Applications may be submitted for three (3) years of support. The
> period of support for funded projects begins July 1, 2006, and ends
> June 30, 2009. For fiscal year 2006, approximately \$10.6 million is
> expected to be available to fund 35 new awards. The average award for
> the first year is \$291,000. **Funding beyond the first year is
> dependent on the availability of appropriated funds for "NWD" in FY
> 2007 [and]{.underline} satisfactory grantee performance.**

**III.** []{#__RefHeading___Toc47265103 .anchor}**ELIGIBILITY
INFORMATION**

[]{#__RefHeading___Toc47265104 .anchor}**1. Eligible Applicants**

> Eligible applicants are schools of nursing, health care facilities, or
> a partnership of such a school and a health care facility, nursing
> centers, academic health centers, State or local governments, an
> Indian Tribe or Tribal organization, other public or private
> non-profit entities including faith-based and community organizations,
> and for-profit entities capable of carrying out the legislative
> purpose.
>
> A new program of nursing that is not accredited at the time of
> submission of a grant application, by reason of an insufficient period
> of operation, but eligible for accreditation by a recognized body or
> bodies or State agency, can be deemed accredited for the purpose of
> these programs if the Secretary of Education finds, after consultation
> with the appropriate accrediting body or bodies, that there is
> reasonable assurance that the program will meet the accreditation
> standards of such a body or bodies prior to the beginning of the
> academic year following the normal graduation date of students of the
> first entering class. Applicants should provide the appropriate
> documentation of accreditation with the application; the documentation
> [will]{.underline} be counted toward the page limit.

[]{#__RefHeading___Toc47265106 .anchor}**2. Cost Sharing/Matching**

Cost sharing is not required for the NWD program.

**3. Other**

Applicants shall submit only one application under this announcement.

> **Maintenance of Effort:**
>
> **Grant funds shall not be used to take place of current funding for
> activities described in the application**. The applicant organization
> 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. Applicants must complete
> and submit the Maintenance of Effort Table located below.

**Maintenance of Effort Table**

NON-FEDERAL EXPENDITURES

+-----------------------------------+-----------------------------------+
| **FY 2005 (Actual)**              | **FY 2006 (Estimated)**           |
|                                   |                                   |
| Actual FY 2005 non-Federal funds, | Estimated FY 2006 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} |                                   |
+-----------------------------------+-----------------------------------+

IV. []{#__RefHeading___Toc47265110 .anchor}**Application and Submission
    Information**

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1.  **Address to Request Application Package**

    **Application Materials**

> Applicants must submit proposals using this guidance in conjunction
> with Health Resources and Services Administration (HRSA) Training Form
> 6025 included with this application guidance document in Appendix A
> and B. These forms may also be obtained electronically from the
> following sites 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 must
> accompany application Form 6025-1 will appear in the "Application
> Format" section below.

**2. Content and Form of Application Submission**

**Application Format Requirements**

> If applying on paper, **the entire application may not exceed 80 pages
> in length**, including the abstract, project and budget narratives,
> attachments, any appendices and letters of commitment and support.
> Pages must be numbered consecutively.
>
> If applying on-line, the total size of all uploaded files may not
> exceed approximately 10 MB, and may not exceed 80 pages when printed
> by HRSA.
>
> **Applications 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.**
>
> ***Additional materials pertinent to an application that are submitted
> after the deadline [will not]{.underline} be included or forwarded for
> consideration. This includes corrected pages, omissions, and letters
> of support. Do not send any materials to the Division of Nursing
> Program Office.***

a.  Number of Copies (Paper Applications only)

> 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

> Please use an easily readable serif typeface, such as Times Roman,
> Courier, or CG Times. The text and table portions of the application
> must be submitted in not less than 12 point and 1.0 line spacing.
> **Applications not adhering to 12point 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.

[]{.mark}

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___Toc47265117 .anchor}**Application Format**

> ***Applications for funding [must]{.underline} consist of the
> following documents in the following order:***

i.  **Application Face Page**

> Applicants shall use the HRSA Form 6025-1 provided with the
> application package (Appendix A of this application guidance
> document). Prepare this page according to instructions provided in the
> form itself. For information pertaining to the Catalog of Federal
> Domestic Assistance, the Catalog of Federal Domestic Assistance Number
> is 93.178. [This is the first page of the grant
> application.]{.underline}
>
> **Data Universal Numbering System (DUNS)**
>
> 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 ).
>
> .

ii. []{#__RefHeading___Toc47265119 .anchor}**Table of Contents**

> Provide a Table of Contents for the remainder of the application
> (including appendices), with page numbers. See "Sample Table of
> Contents" -- **Appendix D**

iii. **Application Checklist**

**The Application Checklist page is found in Appendix C.**

> Carefully review each item on this list and check the appropriate
> spaces. This is the **last page** of the application and should be
> appropriately numbered. For assurances, certification, release of
> information and other requirements, please see **Appendix C** for
> specific information. If there are any questions regarding this
> information, please contact the Division of Grants Management
> Operations at 301-443-6960.

iv. []{#refheading___toc47265121 .anchor}**Budget**

> **Consolidated Budget**
>
> Applicants need to complete the Consolidated Budget sections of the
> Health Resources and Services Administration (HRSA) Form 6025-3
> provided with the application package. Each application must include a
> **Consolidated Budget**. The **Consolidated Budget** provides overall
> budget information for [each]{.underline} year of the grant request.
>
> **Detailed Budget**
>
> Applicants need to complete the Detailed Budget sections of the Health
> Resources and Services Administration (HRSA) Form 6025-2 provided with
> the application package.
>
> **The Detailed Budget** lists the direct costs requested for the first
> year of the project. The applicant must provide an itemized
> cost-effective budget, compatible with stated objectives, and a
> detailed justification/rationale for each budget line item. The
> requested budget and financial plan should reflect institutional
> commitment to the project listing in-kind contributions. **The
> Detailed Budget form is the same for all applications**. **Submit a
> detailed budget page and budget justification for the *first project
> year only*.**

**v.** []{#__RefHeading___Toc47265122 .anchor} **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, HRSA Training Forms 6025. 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 a project period of
> three years. Awards, on a competitive basis, will be for a one year
> budget period, although project periods may be for three (3) 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.
>
> **Caps on expenses**: The maximum amount that can be requested for
> scholarships is \$40,000 per year.
>
> **The following information should be included in the Budget
> narrative:**
>
> **1. Nontrainee Expenses**
>
> **Personnel Costs:** Personnel costs should be explained by listing
> each staff member who will be supported from funds, name (TBA),
> position title, percent full time equivalency, annual salary, and the
> exact amount requested for each project year which mainly covers
> indirect cost. Describe the roles and responsibilities under the
> budget justification for grant supported and non-grant supported
> personnel. This information is essential for reviewers to determine if
> project resources are adequate.
>
> **Consultant Costs:** Give name and institutional affiliation,
> qualifications 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.
>
> **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. ***[The indirect cost associated with the NWD program is set
> at 8%.]{.underline}*** If an organization applying for an assistance
> award 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 which negotiate them
>
> **Fringe Benefits**: List the components that comprise the fringe
> benefit rate, for example - health insurance, taxes, unemployment
> insurance, life insurance, retirement plan, tuition reimbursement. The
> fringe benefits should be directly proportional to that portion of
> personnel costs that are allocated for the project.
>
> **Travel:** List travel costs according to local and long distance
> travel. For local travel, the mileage rate, number of miles, reason
> for travel and staff member/consumers completing the travel should be
> outlined. The budget should also reflect the travel expenses
> associated with participating in meetings and other proposed trainings
> or workshops.
>
> *Note: Project Directors are expected to include in their budgets one
> annual meeting in the Washington, D.C., area to report and share
> experiences with other grantees.*
>
> **Equipment:** List equipment costs and provide justification for the
> need of the equipment to carry out the program's goals. Extensive
> justification and a detailed status of current equipment must be
> provided when requesting funds for the purchase of computers and
> furniture items. ***Proposals for the sole purpose of setting up a
> skills lab are not eligible under the NWD program.***
>
> **Supplies:** List the items that the project will use. In this
> category, separate office supplies from educational purchases. Office
> supplies could include paper, pencils, and the like; and educational
> supplies may be pamphlets, educational videotapes, etc. Remember, they
> must be listed separately.

[]{.mark}

> **Subcontracts:** To the extent possible, all subcontract budgets and
> justifications should be standardized, and contract budgets should be
> presented by using the same object class categories contained in the
> Standard Form 424A. Provide a clear explanation as to the purpose of
> each contract, how the costs were estimated, and the specific contract
> deliverables.
>
> []{.mark}
>
> **Data Collection Activities:** Funds may be used to support
> appropriate and justifiable costs directly related to meeting data
> reporting requirements. Identify and justify how these funds will be
> used under the appropriate budget category.
>
> []{.mark}
>
> **Other Expenses:** Put all costs that do not fit into any other
> category into this category and provide and explanation of each cost
> in this category. In some cases, grantee rent, utilities and insurance
> fall under this category if they are not included in an approved
> indirect cost rate.

2.  **Trainee Expenses**

    A.  **Stipends**

> Enter the number of project students to receive stipends and the total
> stipend amount for each year of the request. Student stipend support
> is provided to assist in covering general living expenses, including
> allowances for travel. Section 821 funds do not permit allowance for
> dependents.
>
> [**The maximum stipend payment of \$250 per month shall be paid to
> eligible project students at regular intervals. The maximum annual (12
> month) amount for stipends (to be prorated and paid on the basis of
> one-twelfth for each month of training) is \$3000 per
> student**.]{.underline}

B.  **Scholarships**

Enter the number of project students to receive scholarships and the
total scholarship amount for each year of the request.

**[Each applicant organization may request up to \$40,000 (maximum) for
scholarship funds annually]{.underline}.**

> **Tuition and Fees**

Make no entry for tuition and fees.

vi. []{#__RefHeading___Toc47265123 .anchor}**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.

vii. **Assurances**

     See the detailed list contained in **Appendix C** (application
     checklist).

viii. []{#refheading___toc47265124 .anchor}**Certifications**

      See the detailed list contained in **Appendix C** (application
      checklist).

      []{#__RefHeading___Toc47265126 .anchor}

      **ix. Project Abstract**

> A project abstract must be provided following the Table of Contents of
> the project application. The project application should be prepared so
> that it is clear, accurate, concise and without reference to other
> parts of the application, because the abstract is often distributed to
> provide information to the public and Congress. 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. The project abstract must be [single-spaced]{.underline} and
> limited to [one]{.underline} 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. (\*Note: this page **[is]{.underline}** counted in the 80
> page limit).
>
> Please place the following information at the top of the abstract:

-   Project Title

-   Applicant Organization Name

-   Project Director

-   Address

-   Contact Phone Numbers (Phone and Fax)

-   Email Address

-   Organizational Website Address

    []{.mark}

    []{#__RefHeading___Toc47265128 .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 Program Narrative:**

-   **Introduction**

-   **Needs Assessment**

-   **Methodology**

-   **Work Plan**

-   **Resolution of Challenges**

-   **Evaluation and Technical Support Capacity**

-   **Organizational Information**

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-   **Introduction**

> This section should briefly describe the purpose of the proposed
> project. The program's purpose is to meet the costs of special
> projects to increase nursing education opportunities for individuals
> from disadvantaged backgrounds (including racial and ethnic minorities
> underrepresented among registered nurses) through retention
> activities, pre-entry preparation, and by providing student
> scholarships or stipends. Applicants must address all three areas.
>
> **Eligible Student Participants**
>
> Students who meet the definition of having an educationally or
> economically disadvantaged background (including students who are
> racial/ethnic minorities underrepresented among nurses) and who
> express an interest in becoming a registered nurse are eligible for
> participation in the NWD program. Program participants must be U.S.
> Citizens, non-citizen nationals, or foreign nationals who possess
> visas permitting permanent residence in the United States.
> **Individuals on temporary student visas are not eligible to receive
> support**. Definitions for educational and economical disadvantaged
> students may be located in **Appendix E** of this application
> guidance.
>
> **Purposes/Focus Areas**
>
> Applicants must address the following three focus areas:

**1. RETENTION ACTIVITIES**[-]{.smallcaps} Retention activities are
designed to assist nursing students from disadvantaged backgrounds to
continue their pursuit of a nursing education. These activities help to
reduce attrition rates and improve graduation rates. Retention
activities should be program and participant specific. Applicants should
target retention goals and document the plan for increasing retention
rates. If retention goes below the rate of previous two years preceding
the grant award, the grantee may risk loosing grant funds.

> Examples of activities include:

-   personal and professional counseling

-   mentoring, tutoring, and coaching

-   professional nursing school entrance examination preparation

-   NCLEX-RN preparation

-   computer skill training

-   advanced technical, academic and social enrichment

-   study skills

-   time management training

-   clinical skills laboratory

-   providing training, information, or advice to faculty with respect
    to encouraging students from disadvantaged backgrounds and/or
    underrepresented minorities to complete the program of nursing
    education in which they are enrolled.

**2. PRE-ENTRY PREPARATION**- Pre-entry activities are designed to
enhance the academic abilities and preparation of students from
disadvantaged backgrounds to increase their competitiveness for entry
into, and graduation from a professional nursing program. These
activities should also identify, motivate, recruit and select potential
candidates for a professional nursing education.

> Pre-entry outreach activities may be geared to elementary, middle and
> high school students (K-12); support the transition from senior high
> school to associate or baccalaureate nursing programs; support CNAs or
> LPNs/LVNs to transition to professional nursing; support associate
> degree RNs to obtain a baccalaureate degree; and prepare collegiate
> pre-nursing students for the nursing program. The proposed project
> must have the registered nurse as the terminal degree.
>
> Examples of pre-entry preparation activities include:
>
> career fairs
>
> future nurses clubs
>
> lecture series
>
> tours, field trips and visits
>
> exposure to clinical settings
>
> programs targeted at improving communication, reading and writing
> skills
>
> reinforcement of basic mathematical skills
>
> enrichment of fundamental knowledge of chemistry, biology and physics
>
> encounters that provide familiarity with basic laboratory equipment
>
> workshops or classes that improve test taking, study and critical
> thinking skills
>
> introduction to medical terminology
>
> computer instruction
>
> mock SATs and ACTs
>
> summer enrichment programs
>
> Saturday academics to support regular curriculum

**3.** **STUDENT STIPENDS OR SCHOLARSHIPS** - Stipends may be awarded to
qualifying students from disadvantaged backgrounds who participate full
time in project activities. Scholarship funds may only be requested for
Nursing Workforce Diversity program participants who are nursing majors
enrolled full-time in a professional nursing program.

**Stipends** may only be provided to 10^th^, 11^th^ and 12^th^ grade
high school students and college students participating full-time in
grant-funded project activities. Students receiving stipends must
participate in all activities of the funded program described in the
grant application.

> When requesting student stipend assistance, applicant institutions are
> required to:
>
> \(a\) Designate a person within the school of nursing or the applicant
> entity to direct and assume responsibility for the stipend program.
>
> \(b\) Adhere to the institution\'s policies and guidelines with the
> application, including eligibility criteria which govern the award and
> monitoring of stipend funds.
>
> \(c\) Maintain documentation, which will enable government auditors or
> other officials to review practices at institutions to determine
> conformance with the established grants policy

Students designated to receive **scholarships** must be in need of
financial assistance in order to pursue the full-time course of study in
the nursing program and must be in good academic standing. The payment
made to the scholarship recipients may or may not meet the total
expenses required by the school for full-time students. **The amount
awarded to each** **student may not exceed \$7,000** per calendar year.
Scholarship funds should be disbursed in logical increments throughout
the academic year and calendar year. Awards that are earmarked to pay
for tuition should be disbursed at the beginning of each period within
the academic year (e.g. semester, trimester, quarter).

**[NOTE]{.underline}: A student may not receive both a scholarship and
stipend concurrently. NWD funds may not be used to support license and
exam costs; NCLEX preparation may be supported.**

> Funds awarded must be used to provide full or partial scholarships to
> eligible full-time students for tuition expenses, other reasonable
> educational expenses, and reasonable living expenses. Students are
> designated to receive scholarships by the grantee institution in
> accordance with the intent of the Nursing Workforce Diversity program
> and the guidelines established by the applicant organization. Grantees
> must use Nursing Workforce Diversity Scholarship funds in a manner
> that will best meet the needs of eligible students.
>
> Requests for scholarship funding must be consistent with the
> activities and project plans outlined in the application. **Applicants
> may request up to a maximum of \$40,000 annually for scholarships**.
> Using the suggested table (Appendix E), enter the number of project
> students to receive stipends and the total stipend amount for each
> year of the request.
>
> Applicant institutions are required to maintain documentation, which
> will enable government auditors or other officials to review practices
> at institutions to determine conformance with established grants
> policy.

-   **NEEDS ASSESSMENT**

> This section outlines the needs of your community and/or organization.
> The target population and its unmet health needs must be described and
> documented in this section. Demographic data should be used and cited
> whenever possible to support the information provided. Please discuss
> any relevant barriers in the service area that the project hopes to
> overcome. This section should help reviewers understand the community
> and/or organization that will be served by the proposed project.
>
> **Competing Continuation Applications**
>
> Applicants are to provide a statement of need for continuation on the
> project: a competing continuation is an extension of the original
> project. For the competing continuation needs statement:

-   Highlight the critical elements documented in the original need
    study and justify the need for three additional years of support (it
    is not necessary to recreate the original need documentation for the
    renewal application such as a feasibility study. The need is to be
    updated as necessary)

-   Provide a Progress Report Summary (see review criteria)

-   Identify gaps in achievement of objectives and work that remains to
    be done

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```
-   **Methodology**

> Propose methods that will be used to meet each of the
> previously-described program requirements and expectations in this
> grant announcement.
>
> **Project Objectives**
>
> Provide measurable, timed objectives with specific outcomes and
> evaluation methods identified for each project year. The objectives
> **must** relate to both the focus areas (retention activities,
> pre-entry preparation, and provision of stipends and scholarships) and
> the identified problems/needs. A separate objective should be included
> for each educational level addressed in the project. These objectives
> must be **measurable** with specific **outcomes** for each project
> year. They must be attainable in the stated time frames. Include
> expected outcomes using numbers and percentages and indicate baselines
> by which success will be measured.
>
> At least [one]{.underline} project specific objective must address how
> the grant project will contribute to meeting at least one of the BHPr
> goals. Approved and funded applicants will be required to provide
> baseline and yearly data on these goals and their corresponding
> outcome(s) in the annual progress report. Specific guidance on these
> requirements is included under the instructions for the "Objective"
> and "Evaluation" sections included in the application guidance
> document.
>
> For competing continuations the original project objectives may be
> updated based on current needs and/or evaluation. One or two new
> objectives should be developed that reflect **expansion or enhancement
> of the original project**. Objectives from the previous project period
> that have been completed may be dropped.

**1. Approach**

Describe by year the activities, methods, and techniques to be used to
accomplish each stated objective. Describe the activities that define
the process and the desired measurable outcome. The description should
include information that clearly indicates what is going to be done and
how it will be done.

> All grant projects using electronic distance learning methodologies
> should include the information below:
>
> ***[Educational Program]{.underline}***

1.  Describe the distance learning method to be used in the project.
    Provide a rationale for the method chosen.

2.  Describe the coursework distance learning students will take.
    Applicants should consider number, sequencing, clinical experiences,
    and length of program. Compare to traditional program where
    appropriate.

3.  Describe the faculty's expertise with the proposed distance learning
    format.

4.  Describe the process for developing distance-learning courses and
    materials.

5.  Describe the measures that will be taken to ensure scholarly
    dialogue and interaction between students and faculty.

6.  Describe how resources will be made available to off-site students.
    These should include library and administrative (i.e., orientation,
    registration) resources.

7.  Describe the plan for evaluating the distance learning methods used.

> ***[Equipment and Technical Support]{.underline}***

1.  Describe the hardware, software, peripherals, and other equipment
    which will be used. Applicants should consider compatibility with
    other computer systems and use and upgrading following the award
    period.

2.  Detail preparation and technical support that will be offered to
    faculty and students.

> ***[Experience and Financing]{.underline}***

1.  Describe the financing of distance learning courses.

2.  Describe the applicant's and any partner organization's previous
    experience with distance learning.

**2. Roles and Responsibilities**

> Specifically describe the functions and time commitment of the Project
> Director and other key staff as well as their academic and
> experiential backgrounds and past experience in working with
> underrepresented minority students or other students from
> disadvantaged backgrounds. Describe current experience, skills, and
> knowledge, including individuals on staff, materials published, and
> previous work of a similar nature.
>
> Position descriptions that include the roles, responsibilities, and
> qualifications of proposed project staff must be included in
> **Appendix B** of your application. 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 C** of your
> application.
>
> **Kids into Health Careers Initiative**
>
> The Kids into Health Careers Initiative is designed to expand the pool
> of qualified and interested applicants from minority and disadvantaged
> populations. The kids into health careers initiative focuses on
> increasing diversity and cultural competency of the health professions
> workforce. The Bureau encourages applicants to participate in the Kids
> into Health Careers initiative by working with primary and secondary
> schools that have a high percentage of minority and disadvantaged
> students. Participation would include establishing linkages with one
> or more elementary, middle, or high schools with a high percentage of
> minority and disadvantaged students to: 1) inform students and parents
> about health careers and financial aid to encourage interest in health
> careers; 2) promote rigorous academic course work to prepare for
> health professions training; and/or 3) provide support services such
> as mentoring, tutoring, counseling, after school programs, summer
> enrichment, and college visits. Applicants are to address this only if
> they have a K-12 Initiative. Kids into Health Careers Initiative
> information may be obtained on the Bureau of Health Professions
> website at: [http://www.bhpr.hrsa.gov.]{.underline}

-   **Work Plan**

> Describe the activities or steps that will be used to achieve each of
> the activities proposed in the methodology section. Use a time line
> that includes each activity, and identifies responsible staff. Provide
> a timetable, at least by quarters, for each project year that
> identifies the appropriate time period for the implementation of
> activities that support project outcomes

-   **RESOLUTIONS OF CHALLENGES**

> Discuss challenges that are likely to be encountered in designing and
> implementing the activities described in the Work Plan, and approaches
> that will be used to resolve such challenges

-   **Evaluation and Technical Support Capacity**

> Evaluation strategy must be tied explicitly to the project objectives
> and the proposed performance outcomes. Specify qualitative and/or
> quantitative evaluation measures (as appropriate) for each objective.
> Describe the methods and techniques which will be used to measure the
> outcomes of the project for each objective. Specify what data will be
> collected, the method for collecting the data, the manner in which
> data will be reported and analyzed, and what personnel will be
> involved with these activities.

Develop a plan for the dissemination of project outcomes or products
such as conferences, presentations, publications, etc. Provide the
program with copies of materials developed for dissemination. On such
work, **include the following disclaimer and acknowledgment:** "*This
project is/was supported by funds from the Division of Nursing (DN),
Bureau of Health Professions (BHPr), Health Resources and Services
Administration (HRSA), Department of Health and Human Services (DHHS)
under \[grant number and title for \$\] (specify grant number, title and
total award amount). The information or content and conclusions are
those of the author and should not be construed as the official position
or policy of, nor should any official endorsement be inferred by, the
DN, BHPr, HRSA, DHHS, or the US Government."*

-   **ORGANIZATIONAL INFORMATION**

> Provide information on the applicant agency's current mission and
> structure, scope of current activities, and an organizational chart,
> and describe how these all contribute to the ability of the
> organization to conduct the program requirements and meet program
> expectations. Include the organizational chart in Appendix E.
>
> Identify institutional and human resources available to implement and
> support the project. Provide evidence of support for the project from
> faculty, administrative and institutional personnel. Summarize past
> performance in assisting students from disadvantaged backgrounds
> (including racial and ethnic minorities underrepresented in nursing).
> Include letters of agreement or letters of support from key
> organizations/individuals of their willingness to perform in
> accordance with the plan presented in the application in Appendix F.

Provide specific information that describes the extent and means by
which your program plans to become self-sufficient. This should include
other sources of income and the nature of the income, future funding
initiatives and strategies, decremental Federal funding plans by year
for the remaining project period, and a timetable for becoming
self-sufficient. Describe problems to overcome in order to become
self-sufficient.

**xi. Program Specific Forms**

> The applicant must complete the NWD program tables identified as
> Admissions to the Overall Nursing Program, Total Enrollment and
> Graduation by Race/Ethnicity and Disadvantaged Status be completed by
> all applicants (Appendix G).

[]{.mark}

**xii.** []{#__RefHeading___Toc47265130 .anchor}**Appendices**

> Please provide the following items 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. Be
> sure each appendix is clearly labeled.]{.underline}

1)  ***Appendix A*:** Tables, Charts, etc.

> To give further details about the proposal.

2)  ***Appendix B:*** Job Descriptions for Key Personnel

> Keep each to one page in length as much as is possible.

3)  ***Appendix C:*** Biographical Sketches of Key Personnel

> Include biographical sketches for persons occupying the key positions
> described in Appendix B, not to exceed two pages in length. In the
> event that a biographical sketch is included for an identified
> individual who is not yet hired, please include a letter of commitment
> from that person with the biographical sketch.

4)  ***Appendix D:*** Letters of Agreement and/or Description(s) of
    Proposed/Existing Contracts (project specific). Provide any
    documents that describe working relationships between the applicant
    agency and other agencies and programs cited in the proposal.
    Documents that confirm actual or pending contractual agreements
    should clearly describe the roles of the subcontractors and any
    deliverable. Letters of agreements must be dated.

5)  ***Appendix E:*** Project Organizational Chart

> Provide a one-page figure that depicts the organizational structure of
> the project, including subcontractors and other significant
> collaborators.

6)  ***Appendix F:*** Other Relevant Documents

> Include here any other documents that are relevant to the application,
> including letters of supports. Letters of support must be dated.
> **Include only letters of support which specifically indicate a
> commitment to the project/program (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___Toc47265131 .anchor}**3. Submission Dates and Times**

**Application Due Date**

> The due date for applications under this grant announcement is
> **January 12, 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 **5 P.M. ET on 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 on the due date**.
> **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.

**4. Intergovernmental Review**

> The Nursing Workforce Diversity program is not subject to the
> provisions of Executive Order 12372, as implemented by 45 CFR 100.
> []{#__RefHeading___Toc47265139 .anchor}

**5. Funding Restrictions**

> Awards to support projects beyond the first budget year will be
> contingent upon Congressional appropriation, satisfactory progress in
> meeting the project's objectives, and a determination that continued
> funding would be in the best interest of the government.
>
> Each applicant organization may request up to \$40,000 (maximum) for
> scholarship funds annually.

[]{#__RefHeading___Toc47265140 .anchor}

**6. Other Submission Requirements**

**Applicants shall submit only one application under this
announcement.**

**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 below 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 in 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 *TWO
> (2)* copies of the application to:

[]{.mark}

> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: **Nursing Workforce Diversity Program**
>
> Program Announcement No. **HRSA-06-035**
>
> CFDA No. 93.178
>
> 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___Toc47265142 .anchor}**V. Application Review
Information**

[[]{#Review_ReviewCriteria .anchor}]{.mark}

**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.
>
> The NWD program has seven (7) review criteria. All applications will
> be evaluated by peer reviewers based on the criteria listed below. The
> points allocated to each criterion are provided beside each criterion.
> The weights are based on a total possible score of 100. The peer
> reviewers will use these values during the technical review process to
> determine the extent to which the applicant meets the following
> criteria:
>
> **Criteria 1a. Need: Purpose, Need, Rationale (New =20 points,
> Competing Continuation=15 points)**

-   The purpose is clearly stated and is consistent with the legislative
    intent

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-   The need for the proposed project thoroughly describes the problem
    and associated contributing factors to the problem including:

    -   The health care needs (such as demographics, morbidity and
        mortality, acute and chronic health conditions) of the
        populations who will be served by the program's participants;

    -   How will the proposed project effect the health care needs of
        the target population(s);

    -   Documented evidence of an eligible enrollee, project and/or
        applicant pool, including potential students from
        underrepresented minority backgrounds;

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-   Rationale describes how the proposed project will contribute to
    meeting the documented needs. Rationale is provided for how the
    project contributes to meeting the documented needs, how it is
    consistent with related Federal, State, and regional workforce
    programs, plans, and priorities and how it will contribute to
    increasing nursing workforce diversity.

> **Criteria 1b. Progress Report Summary (New=NA, Competing
> Continuation=10 points)**
>
> ***[Progress Report Summary (Competing Continuations
> only)]{.underline}*** A clearly stated need for
> [continuing]{.underline} grant support for the project is provided by
> competing continuation applicants.
>
> The Progress Report should provide adequate information that
> demonstrates progress towards the project meeting the objectives and
> outcomes of the program. **The summary of the report should include**:

-   **The project period of the initial grant application.** All
    activities related to the current **project** period.

-   The original objectives of the initial project. For each of the
    stated objective provide outcome data in quantitative and
    qualitative terms using actual numbers and percentages. Indicate the
    **baselines** by which outcomes (results) were measured; and

-   Milestones that have been achieved and their significance. Where
    milestones have not been achieved, indicate the reasons and what
    action will be taken to address the issue(s).

> **Criteria 2. Response: Project Plan (New =20 points, Competing
> Continuation=20 points)**

-   The objectives for the project relate to both the identified
    problems/needs and the program purpose of increasing nursing
    education opportunities for individuals from disadvantaged
    backgrounds (including underrepresented minorities) through
    pre-entry preparation, provision of stipends, and retention
    activities.

-   At least one objective that addresses one of the BHPr goals is
    included.

-   Objectives are measurable, realistic, and have specific outcomes
    indicated with time-frames stated.

-   An outcome objective is included for each educational level of
    student projected to participate in the project.

> **Criteria 3. Evaluative Measures (New=10 points, Competing
> Continuation=10 points)**
>
> The proposed methods for evaluating the project are described
> including:

-   The data collection, analysis and reporting procedures to be used,
    and the personnel involved;

-   Appropriate quantitative and/or qualitative evaluation measures for
    each objective and;

-   Outcome and process evaluation indicators.

> A plan for dissemination of information about the results of the
> project is provided.
>
> **Criteria 4. Impact (New=20 points, Competing Continuation=20
> points)**

-   Activities are described which will be used to accomplish each
    objective for each year of the project and are appropriate for the
    student participants.

-   Proposed activities are reasonable given the proposed level of
    staff, resources available, length of the project period, the
    qualifications of the project director and staff, and the adequacy
    of the facilities available to the applicant to carry out the
    proposed project.

-   Established and/or planned linkages and partnerships with relevant
    educational and health care entities, and interdisciplinary
    education programs for other health professionals are described, are
    relevant to project objectives, and will assist in the attainment of
    project objectives.

-   Distance learning methodology guidance is addressed, if applicable.

> **Criteria 5**. **Resources/Capabilities (New=15 points, Competing
> Continuation=15 points)**

-   Evidence is provided of the institution's commitment, experience,
    and success in working with students from disadvantaged backgrounds
    (including racial and ethnic minorities underrepresented among
    registered nurses).

> **Criteria 6. Support Requested (New=10 points, Competing
> Continuation=5 points)**

-   The administrative and managerial capability of the applicant to
    carry out the project is demonstrated.

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-   Evidence of support for the project from faculty, administrative,
    and institutional personnel is provided.

-   Letters of agreement or support are provided from key
    organizations/individuals indicating their willingness to perform in
    accordance with the plan presented in the application.

-   A fiscal plan assuring effective use of grant funds and resources to
    carry out the project is provided. The proposed budget is reasonable
    and reflects effective use of the funds requested. It is accompanied
    by a detailed justification for each line item. The level of in-kind
    support and other sources of funds, both Federal and non-Federal,
    that the applicant proposes to use for carrying out the project are
    indicated.

**Criteria 7. Self Sufficiency (New=5 points, Competing Continuation=5
points)**

-   Specific information is provided that describes the extent and means
    by which the project plans to become self-sufficient after the
    period of grant support including:

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-   Other sources of income; the nature of income, future funding
    initiatives and strategies, decremental Federal funding plans by
    year, and a timetable for becoming self-sufficient.

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-   Problems to overcome to reach self-sufficiency are discussed.

**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 being reviewed. 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.

[]{.mark}

**Funding Preferences**

The authorizing legislation provides a statutory funding preference for
some applicants. Applications receiving the preference will be placed in
a more competitive position among applications that can be funded.
Applications that do not receive a funding preference will be given full
and equitable consideration during the review process. The authorizing
law provides that a funding preference be granted to any qualified
applicant that specifically requests the preferences and meets the
criteria for the preference as follows:

-   Applicants must request the statutory funding preference if the
    project substantially benefits the **rural or underserved
    populations, or helps meet public health nursing needs** in state or
    local health departments. Applicants must also demonstrate how this
    application meets the statutory funding preference

    []{#__RefHeading___Toc47265150 .anchor}**3. Anticipated Announcement
    and Award Dates**

    All eligible NWD applications that are received by the application
    deadline will be forwarded to the Peer Reviewer for review,
    evaluation, and scoring determinations. All applicants will be
    notified by mail regarding their peer review score and grant award
    potential. All funding determinations will be completed in a timely
    manner to enable HRSA to make awards by the
    []{#__RefHeading___Toc47265153 .anchor}July 1, 2006 project start
    date.

    **VI. Award Administration
    Information**[]{#__RefHeading___Toc47265154 .anchor}

    []{.mark}

    **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.

[]{#__RefHeading___Toc47265156 .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 2010**

> **Healthy People 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 program 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. 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___Toc47265158 .anchor}

**3. Reporting**

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).

> All Bureau of Health Professions grantees are required to submit
> progress reports to HRSA on an annual basis. These reports take the
> form of Uniform Progress Reports (UPR I & II), Final Reports and
> Comprehensive Performance Management System (CPMS) Reports. The UPR I
> section allows the grantee to report on project objectives while UPR
> II focuses on program specific data variables. CPMS builds on the BHPr
> focus of assuring access through programs that improve the
> distribution, diversity and quality of the healthcare workforce, as
> seen in the BHPR goals already discussed earlier in this document.
>
> Progress reports must be submitted on-line by the grantee. The
> 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 BHPR's web page address is
> [www.bhpr.hrsa.gov/grants](http://www.bhpr.hrsa.gov/grants) and once
> on the web page, click on **Grantee Reports**.
>
> **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___Toc47265160 .anchor}**VII. Agency Contacts**

[]{.mark}

Applicants may obtain additional information regarding business,
administrative, or fiscal issues related to this grant announcement by
contacting:

[]{.mark}

Jackie Whitaker

Division of Grants Management Operations, OFAM

5600 Fishers Lane Room

Rockville, MD 20857

Telephone: 301 443-3893

Fax: 301 443-6343

> E-mail: Jwhitaker@hrsa.gov

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

> Janice B. Young, Ph.D., MPH, RN
>
> Nurse Consultant, Division of Nursing
>
> Bureau of Health Professions, HRSA
>
> 5600 Fishers Lane Room 9-36
>
> Rockville, MD 20857
>
> Telephone: 301 443-6193
>
> Fax: 301 443-0791
>
> E-mail: <Jyoung2@hrsa.gov>

**VIII. Tips for Writing a Strong Application**

**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.

I**X. Appendices**

**Appendix A**

OMB Approval No. 0915-0060 Expiration Date: 08/31/2006

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

HRSA-6025-1 (Revised 6/00) Created in Microsoft Word

**Appendix B**

OMB Approval NO. 0915-0060 Expiration Date: 08/31/2006

**DETAILED BUDGET**

**Program Area: Discipline:**

+--------------+----------------+------+------+------+--------+-------+
| **Direct     |                |      |      |      |        |       |
| Costs Only** |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **A.         |                |      |      |      |        |       |
| Non-trainee  |                |      |      |      |        |       |
| Expenses**   |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Personnel  |                | **T  |      | **Do |        |       |
| (Do not list |                | ime/ |      | llar |        |       |
| trainees)**  |                | Effo |      | Am   |        |       |
|              |                | rt** |      | ount |        |       |
|              |                |      |      | Req  |        |       |
|              |                |      |      | uest |        |       |
|              |                |      |      | ed** |        |       |
|              |                |      |      |      |        |       |
|              |                |      |      | **(  |        |       |
|              |                |      |      | Omit |        |       |
|              |                |      |      | Cent |        |       |
|              |                |      |      | s)** |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Name**     | **Title of     | *    | **H  | **   | **     | **To  |
|              | Position**     | *%** | ours | Sala | Fringe | tal** |
|              |                |      | per  | ry** | Bene   |       |
|              |                |      | we   |      | fits** |       |
|              |                |      | ek** |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
|              |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
|              |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
|              |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
|              |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
|              |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
|              |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
|              |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
|              |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| *            |                |      |      |      |        |       |
| *Subtotals** |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Consultant |                |      |      |      |        |       |
| Costs**      |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Equipment  |                |      |      |      |        |       |
| (Itemize)**  |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| *            |                |      |      |      |        |       |
| *Contracts** |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Supplies   |                |      |      |      |        |       |
| (Itemize by  |                |      |      |      |        |       |
| category)**  |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Staff      |                |      |      |      |        |       |
| Travel**     |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Other      |                |      |      |      |        |       |
| Expenses     |                |      |      |      |        |       |
| (Itemize by  |                |      |      |      |        |       |
| category)**  |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Subtotals  |                |      |      |      |        |       |
| (Section     |                |      |      |      |        |       |
| A)**         |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **B. Trainee |                |      |      |      |        |       |
| Expenses     |                |      |      |      |        |       |
| (Not         |                |      |      |      |        |       |
| Allowable    |                |      |      |      |        |       |
| for the NEPR |                |      |      |      |        |       |
| Program)**   |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **           |                |      |      |      |        |       |
| Pre-doctoral |                |      |      |      |        |       |
| Stipends No. |                |      |      |      |        |       |
| requested:** |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **           |                |      |      |      |        |       |
| Postdoctoral |                |      |      |      |        |       |
| Stipends No. |                |      |      |      |        |       |
| requested:** |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Other      |                |      |      |      |        |       |
| (Specify)    |                |      |      |      |        |       |
| No.          |                |      |      |      |        |       |
| requested:** |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Total      |                |      |      |      |        |       |
| Stipends**   |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Tuition    |                |      |      |      |        |       |
| and Fees**   |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Trainee    |                |      |      |      |        |       |
| Travel       |                |      |      |      |        |       |
| (Describe)** |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **Subtotal   |                |      |      |      |        |       |
| (Section     |                |      |      |      |        |       |
| B)**         |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+
| **C. Total   |                |      |      |      |        |       |
| Direct Costs |                |      |      |      |        |       |
| (Add         |                |      |      |      |        |       |
| Subtotals of |                |      |      |      |        |       |
| Sections A   |                |      |      |      |        |       |
| and B)**     |                |      |      |      |        |       |
+--------------+----------------+------+------+------+--------+-------+

HRSA-6025-2 (Formerly PHS-6025-2)(revised 06/2000)

> **OMB Approval NO. 0915-0060**
>
> **Expiration Date: 06/30/2003**

**Part 1 - Consolidated Budget Form, Part 1**

+---------------+------+-------+------+------+------+---------------+
| **Direct      | **F  | **S   | **T  | *    | **Fi | **Total**     |
| Costs**       | irst | econd | hird | *Fou | fth\ |               |
|               | Bu   | B     | Bu   | rth\ | Bud  |               |
|               | dget | udget | dget | Bud  | get\ |               |
|               | Peri | Per   | Peri | get\ | Peri |               |
|               | od** | iod** | od** | Peri | od** |               |
|               |      |       |      | od** |      |               |
+---------------+------+-------+------+------+------+---------------+
| **A.          |      |       |      |      |      |               |
| Nontrainee    |      |       |      |      |      |               |
| Expenses**    |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Personnel     |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Consultant    |      |       |      |      |      |               |
| Costs         |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Equipment     |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Contracts     |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Supplies      |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Staff Travel  |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Other         |      |       |      |      |      |               |
| Expenses      |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| **Subtotal    |      |       |      |      |      |               |
| Section A**   |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| **B. Trainee  |      |       |      |      |      |               |
| Expenses**    |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Stipends      |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Tuition &     |      |       |      |      |      |               |
| Fees          |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| Trainee       |      |       |      |      |      |               |
| Travel        |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| **Subtotal    |      |       |      |      |      |               |
| Section B**   |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| **Total       |      |       |      |      |      |               |
| Direct        |      |       |      |      |      |               |
| Costs**       |      |       |      |      |      |               |
|               |      |       |      |      |      |               |
| **(Add        |      |       |      |      |      |               |
| Subtotals of  |      |       |      |      |      |               |
| Sections A &  |      |       |      |      |      |               |
| B)**          |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| **Total       |      |       |      |      |      |               |
| Indirect      |      |       |      |      |      |               |
| Costs**       |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+
| **Total       |      |       |      |      |      |               |
| Project       |      |       |      |      |      |               |
| Costs**       |      |       |      |      |      |               |
+---------------+------+-------+------+------+------+---------------+

**Part 2 - Consolidated Budget Form, Part 2**

  ---------------- ---------- ---------- ---------- ----------- ---------- ----------------
  **Estimated      **First    **Second   **Third    **Fourth\   **Fifth\   **Total**
  Funding**        Budget     Budget     Budget     Budget\     Budget\    
                   Period**   Period**   Period**   Period**    Period**   

  Federal                                                                  
  (Requested in                                                            
  this                                                                     
  Application)                                                             

  Other Federal                                                            

  Applicant                                                                
  Institution                                                              

  State,                                                                   
  Local/Other                                                              

  Program Income                                                           

  **Total**                                                                
  ---------------- ---------- ---------- ---------- ----------- ---------- ----------------

Indirect Costs Requested \_\_\_\_\_ Yes\_\_\_\_ No If "Yes," at
\_\_\_\_\_\_ % rate. HRSA-6025 (Formerly PHS-6025) (Revised 06/00)

**OMB Approval NO. 0915-0060**

Expiration Date: 08/31/2006

**Appendix C**

**APPLICATION CHECKLIST**

+-----------------------------------------------------------------------+
| **APPLICATION CHECKLIST**                                             |
|                                                                       |
| > This is the required last page of the application it should not be  |
| > numbered, and it will not be counted in the page limitation.        |
|                                                                       |
| (**Check the appropriate boxes and provide the information            |
| requested**.)                                                         |
|                                                                       |
| [TYPE OF APPLICATION]{.underline}                                     |
|                                                                       |
| [\_\_\_\_]{.underline} New Application (This application is being     |
| submitted to HRSA for a project or program not currently receiving    |
| funding from this program)                                            |
|                                                                       |
| \_\_\_\_Competing Continuation Application for initial Grant Number   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_(This application is being submitted to     |
| HRSA for a project or program that is currently receiving grant       |
| funding from this program)                                            |
|                                                                       |
| [ASSURANCES, CERTIFICATIONS AND OTHER REQUIREMENTS]{.underline}       |
|                                                                       |
| Please see the following 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.                |
|                                                                       |
| \_\_\_\_ Yes \_\_\_\_ No (If "No", provide an explanation.)           |
|                                                                       |
| [DATA UNIVERSAL NUMBERING SYSTEM (DUNS)]{.underline}                  |
|                                                                       |
| [\_\_\_\_]{.underline} DUNS number has been completed on the face     |
| page.                                                                 |
+-----------------------------------------------------------------------+

> **ASSURANCES, CERTIFICATIONS AND OTHER REQUIREMENTS**
>
> For assurances, certification and other requirements, please see the
> following instructions.
>
> If there are any questions regarding this information, please contact
> the HRSA Division of Grants Management Operations at (301) 443-3893.
>
> If the applicant has met the requirements of each of the following
> assurances, certifications and other requirements, please check the
> "YES" space on the Checklist. If one or more of the following
> assurances, certifications and other requirements are not met, check
> "NO" and explain.

A.  **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 ground 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.

B.  **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 DHHS 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 subject to
    discrimination under any program or activity receiving Federal
    financial assistance. Pertinent DHHS regulations are found in 45 CFR
    Part 84.

C.  **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 DHHS-690) must be on file
    with the Office for Civil Rights, Office of the Secretary, DHHS,
    before a grant may be made.

D.  **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 DHHS
    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 an education program or activity receiving Federal financial
    assistance. Pertinent DHHS regulations are found in 45 CFR Part 86.

E.  In accordance with Sections 794 and 810 of the Public Health Service
    Act and 45 CFR Part 83, no grant, cooperative agreement, loan
    guarantee, or interest subsidy payment under Title VII or VIII of
    the PHS Act shall be made to or for the benefit of any entity, and
    no contract under Titles VII and VIII of the PHS Act shall be made
    with 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.

F.  **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 which
    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.

G.  **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 requires certification that
    grantees will provide and maintain a drug-free workplace.

H.  **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. Restrictions on lobbying are found at 45 CFR Part 93. In
    addition, government-wide guidance for restrictions on lobbying was
    published by the Office of Management and Budget (54 FR 52306,
    December 20, 1989).

I.  **Misconduct in Science:** Each institution which 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 the requirements of the Final Rule as
    published in the *Federal Register* at 54 FR 32449, August 8, 1989.

J.  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
    (OR), acceptable assurances for dealing with and reporting possible
    misconduct in science. The respective Grants Management Office will
    determine the status of an institution by contacting OR.

K.  **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. Subawardees, 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 nonprocurement debarment and suspension.

L.  **Statement of Non-Delinquency on Federal Debt:** The 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.

M.  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.

N.  **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 must 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 which received 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.

O.  **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 DHHS 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 blood borne
    diseases.

P.  **Smoke-Free Workplace:** The Public Health Service strongly
    encourages all grant and cooperative agreement recipients to provide
    a smoke-free workplace and promote the non-use 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.

> **Appendix D**

+-----------------------------------------------------------------------+
| **SAMPLE TABLE OF CONTENTS**                                          |
|                                                                       |
| Page                                                                  |
|                                                                       |
| I.  Face Page 1                                                       |
|                                                                       |
| II. Project Synopsis                                                  |
|     ....................................                              |
| ....................................................................2 |
|                                                                       |
| III. Table of Contents 3                                              |
|                                                                       |
| IV. Project                                                           |
|     Abstract......................................................... |
|     continue numbering as appropriate                                 |
|                                                                       |
| V.  Budget...............................................             |
| ..................................................................... |
|                                                                       |
| A. Detailed                                                           |
| Budget..........................                                      |
| ..................................................................... |
|                                                                       |
| > B. Consolidated                                                     |
| > Budget.....................                                         |
| ..................................................................... |
|                                                                       |
| C. Maintenance of Effort                                              |
|                                                                       |
| VI. Project Narrative (Detailed Description of Project)               |
|                                                                       |
| > A. Introduction                                                     |
| >                                                                     |
| > B. Needs Assessment                                                 |
| > .......................                                             |
| ..................................................................... |
| >                                                                     |
| > C. Methodology                                                      |
| >                                                                     |
| > D. WorkPlan                                                         |
|                                                                       |
| E. Evaluation and Technical Support Capacity                          |
|                                                                       |
| > F. Organizational Information                                       |
| >                                                                     |
| > G. Funding Factor, Statutory Funding Preference                     |
|                                                                       |
| V. Appendices                                                         |
|                                                                       |
| > VI\. Application                                                    |
| > Checklist............................                               |
| ..................................................................... |
+-----------------------------------------------------------------------+

> **Appendix E**

**PROGRAM DEFINITIONS:**

The following definitions shall apply to the *Nursing Workforce
Diversity Grant Program* for Fiscal Year 2006.

**"Academic Health Center"** refers to an institution that includes a
school of medicine, a teaching hospital, and at least one additional
health education program (e.g., nursing) and which is owned and/or
affiliated with clinical agencies providing for the delivery of patient
services. Each entity generally maintains a separate identity and
autonomy.

**"Access"** means to assure health care services to all by improved
health professions distribution.

**"Accredited"** means a program accredited by a recognized body or
bodies, or by a State agency approved for such purposes by the Secretary
of Education and when applied to a hospital, school, college or
university (or unit thereof) means a hospital, school, college or
university (or unit thereof) which is accredited by a recognized body or
bodies, or by a State agency, approved for such purpose by the Secretary
of Education.

**"Assistive Nursing Personnel"** refers to unlicensed individuals who
assist nursing staff in the provision of basic care to clients and who
work under the supervision of licensed nursing personnel. Included in
this category are nurses' aides, nursing assistants, orderlies,
attendants, personal care aides, home health aides, and technicians.

**"Associate Degree School of Nursing"** means a department, division or
other administrative unit in a junior college, community college,
college, or university which provides primarily or exclusively a
two-year program of education in professional nursing and allied
subjects leading to an associate degree, but only if such program, or
such unit, college or university is accredited.

**"Collegiate School of Nursing"** means a department, division, or
other administrative unit in a college or university which provides
primarily or exclusively a program of education in professional nursing
and allied subjects leading to a degree of bachelor of arts, bachelor of
science, bachelor of nursing, or to an equivalent degree, or to a
graduate degree in nursing, and including advanced education related to
such program of education provided by such school, but only if such
program, or such unit, college or university is accredited.

**"Cultural Competence"** means a set of academic and interpersonal
skills that allow an individual to increase their understanding and
appreciation of cultural differences and similarities within, among and
between groups. This requires a willingness and ability to draw on
community-based values, traditions, and customs and to work with
knowledgeable persons of and from the community in developing targeted
interventions, communications, and other supports.

**"Culturally Competent Program"** means a program that demonstrates
sensitivity to and understanding of cultural differences in program
design, implementation, and evaluation.

**"Cultural Diversity"** means differences in race, ethnicity, language,
nationality, or religion among various groups within a community, an
organization, or a nation.

**"Diploma School of Nursing"** means a school affiliated with a
hospital or university, or an independent school, which provides
primarily or exclusively a program of education in professional nursing
and allied subjects leading to a diploma or to equivalent indicia that
such program has been satisfactorily completed, but only if such
program, or such affiliated school or such hospital or university or
such independent school is accredited.

**"Distance Learning Methodologies"** means electronic media are used to
deliver educational content when the learner and teacher are separated
by distance. An electronic medium may be a computer, World Wide Web
technologies, teleconferencing, television, or CD ROM/DVD.

**"Elementary School"** generally refers to grades kindergarten through
grade 5 or 6 depending on the school district.

**"Faculty Development"** means activities and/or programs designed to
assist project faculty to develop theory and practice skills to improve
their ability to teach.

**"Full-time Student"** means a student who is enrolled on a full-time
basis as defined by the institution.

**"Graduate"** means an individual who has successfully completed all
institutional requirements necessary to be granted a degree/certificate.

**"Individual from a Disadvantaged Background"** as authorized by
Section 821 of the Act refers to an individual who:

1)  comes from an environment that has inhibited them from obtaining the
    knowledge, skills, and abilities required to enroll in and graduate
    from a school of nursing (**Educationally Disadvantaged**). The
    following are provided as examples of "Educationally Disadvantaged"
    for guidance only and are not intended to be all-inclusive.
    Applicants should seek guidance from their educational institution
    as to how "Educationally Disadvantaged" is defined by their
    institution.

Examples:

1.  Person from high school with low average SAT/ACT scores or below the
    average State test results.

2.  Person from a school district where 50% or less of graduates go to
    college.

3.  Person who has a diagnosed physical or mental impairment that
    substantially limits participation in educational experiences.

4.  Person for who English is not their primary language and for whom
    language is still a barrier to their academic performance.

5.  Person who is first generation to attend college.

6.  Person from a high school where at least 30% of enrolled students
    are eligible for free or reduced price lunches.

**or**

2)  comes from a family with an annual income below a level based on
    low-income thresholds established by the U.S. Census Bureau,
    adjusted annually for changes in the Consumer Price Index
    **(Economically Disadvantaged).**

> For FY 2005, HRSA has determined that\`\`**Low**-**income** level\'\'
> as applied to a family is one with an annual **income** that is below
> 200 percent of HHS\'s poverty guidelines, as indicated in the table
> below, and a family is a group of two or more individuals related by
> birth, marriage, or adoption who live together or an individual who is
> not living with any relatives.
>
> FY 2005 **Low** **Income** **Levels**
>
> \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--
>
> **Income**
>
> Persons in family \* level \*\*
>
> \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--
>
> 1\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> \$18,620
>
> 2\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 24,980
>
> 3\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 31,340
>
> 4\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 37,700
>
> 5\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 44,060
>
> 6\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 50,420
>
> 7\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 56,780
>
> 8\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
> 63,140
>
> \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--
>
> \* Includes only dependents reported on Federal **Income** tax forms
> for
>
> calendar year 2003.
>
> \*\* Adjusted gross **income** for calendar year 2003.

**"Licensed Practical/Vocational Nurse (LPN/LVN)"** means an individual
who is currently licensed as a licensed practical nurse or a licensed
vocational nurse in at least one jurisdiction of the United States and
employed in a nursing facility or home health agency.

**"Local Government"** means a local unit of government, including
specifically a county, municipality, city, town, township, local public
authority, school district, special district, intra-State district,
council of governments (whether or not incorporated as a nonprofit
corporation under State law), or any other regional or interstate
entity, or any agency or instrumentality of local government.

**"Medically Underserved Communities"** as defined in section 799(6) of
the law, means an urban or rural area or population that:

\(1\) is eligible for designations under section 332 as a health
professional shortage area;

(2) is eligible to be served by a migrant health center (MHC) under
    section 329, a community health center (CHC) under section 330, a
    grantee under section 340 (relating to homeless individuals), or a
    grantee under section 340A (relating to residents of public
    housing); or

(3) 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).

In keeping with the Congressional intent that eligible entities should
not be limited to formally designated Health Professional Shortage Areas
(HPSA\'s) and populations served by CHCs, MHCs, or homeless health
centers, the list of types of practice sites that can be claimed under
this provision has been expanded to include the following:

-   Community Health Centers (CHC) (section 330)

-   Migrant Health Centers (MHC) (section 329)

-   Health Care for the Homeless Grantees (section 340)

-   Public Housing Primary Care Grantees (section 340A)

-   Rural Health Clinics, federally designated (section 1861(aa)(2) of
    the Social Security Act)

-   National Health Service Corps (NHSC) Sites, freestanding (section
    333)

-   Indian Health Services (IHS) Sites (Pub. L. 93-638 for tribal
    governed sites and

Pub. L. 94-437 for IHS operated sites)

-   Federally Qualified Health Centers (section 1905 (a) and (1) of the
    Social Security Act)

-   Primary Medical Care Health Professional Shortage Areas (HPSA\'s)
    (facilities and

> geographic) (section 332), for primary care physicians, other
> personnel except dentists and nurses

-   Dental HPSA's (facilities and geographic) (section 332) for dentist
    only

-   Nurse Shortage Areas (section 846)

-   State or Local Health Departments (regardless of sponsor - for
    example, local health

departments who are funded by the state would qualify)

-   Ambulatory practice sites designated by State Governors as serving
    medically underserved communities

```{=html}
<!-- -->
```
-   Information on HPSAs, CHCs, MHCs, and/or homeless health centers is
    available on

> HRSA's web site under the Bureau of Primary Health Care (BPHC) at
> \<http://www.bphc.hrsa.gov/bphc.database.htm\> or you may call
> 1-800-400-2742.

**"Middle School"** refers to either grades six, seven, and eight or
grades, seven, eight and nine, depending on the school district.
Synonymous with junior high school.

**"Minority"** means an individual whose race/ethnicity is classified as
American Indian or Alaska Native, Asian, Black or African American,
Hispanic or Latino, Native Hawaiian or Pacific Islander.

**"National of the United States"** means a citizen of the United States
or a person who, though not a citizen of the United States, owes
permanent allegiance to the United States (as defined in 8 U.S.C. 110
(a) (22), the Immigration and Nationality Act)(8 U.S.C. 110(a)(22).

**"Nonprofit"** means any school, agency, organization or institution
which is a corporation or association or is owned and operated by one or
more corporations or associations, no part of the net earnings of which
inures, or may lawfully inure to the benefit of any private shareholder
or individual as defined in Section 801(7) of the PHS Law.

**"Nursing Center"** means an organization in which the client has
direct access to professional nursing service. Nurses in these centers
are responsible and accountable for diagnosing, treating, and promoting
health and optimal functioning of the client. Overall center
accountability remains with the nurse executive. Nursing centers are
commonly referred to as nurse-managed clinics, community nursing
centers, nursing clinics, or nursing practice arrangements.

**"Nursing Practice Arrangement"** means a delivery system managed by a
school of nursing and operated by faculty, students, and staff to
increase access to primary health care for medically underserved
communities and populations.

**"Pre-entry Preparation"** refers to pre-entry activities designed to
encourage, inform, and prepare elementary, middle and senior high school
students (K-12) of educational and career opportunities in nursing;
pre-entry activities that will support the transition from senior high
school to associate, professional and/or baccalaureate nursing programs;
and pre-entry activities that prepare collegiate pre-nursing students
for the nursing program (pre-nursing curriculum).

**"Professional Nurse"** means a registered nurse who has received
initial nursing preparation from a diploma, associate degree, or
collegiate school of nursing and who is currently licensed in a State to
practice nursing.

**"Program"** means a combination of identified courses and other
educational or training experiences at a specified academic level, the
sum of which provides the required competence (ies) to practice.

**"Project"** refers to all proposed activities, including educational
programs, specified or described in an application.

**"Racial/Ethnic Categories"** the following definitions of
racial/ethnic categories should be used:

**[American Indian or Alaska Native:]{.underline}** a person having
origins in any of the original peoples of North and South America
(including Central America), and who maintains tribal affiliation or
community attachment.

**[Asian:]{.underline}** a person having origins in any of the original
peoples of the Far East, Southeast Asia, or the Indian subcontinent
including, for example, Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand and Vietnam.

**[Black or African American:]{.underline}** a person having origins in
any of the black racial groups of Africa. Terms such as "Haitian or
Negro" can be used in addition to "Black or African American".

**[Hispanic or Latino:]{.underline}** A person of Mexican, Puerto Rican,
Cuban, Central or South American or other Spanish culture or origin
regardless of race. The term "Spanish Origin" can be used in addition to
"Hispanic or Latino".

**[Native Hawaiian or Other Pacific Islander:]{.underline}** a person
having origins in any of the original peoples of Hawaii, Guam, Samoa, or
other Pacific Islands.

**[White:]{.underline}** A person having origins in any of the original
peoples of Europe, North Africa, or the Middle East.

**"Registered Nurse"** means a person who has graduated from a school of
nursing and is licensed to practice as a registered or professional
nurse in a State.

**"Retention Activities"** refer to activities conducted by the grantee
that help nursing students (from disadvantaged backgrounds) to continue
their pursuit of a nursing education. These activities help to reduce
attrition rates and improve graduation rates for those students.

**"Rural Area"** means an area other than a Metropolitan Statistical
Area (MSA) as designated by the Office of Management and Budget based on
current census data. Census tracts in certain metropolitan areas may
also be eligible if they are located a significant distance from the
major city in the Standard Metropolitan Area (SMA). Rural means people
who live in places with small populations or unincorporated areas with
population density less than 1,000 per square mile. A rural place is any
incorporated place or Census Designated Place with fewer than 2500
inhabitants that is located outside of an Urbanized Area (UA). An UA is
defined as a continuously built-up area with a population of 50,000 or
more.

**"Rural Clinical Experience"** means a structured primary care clinical
experience in any appropriate outpatient, home health, public health
agency setting or hospital located in a rural area.

**"Rural Health Facility"** means a hospital of less than 100 beds or
other patient care facility located outside Office of Management and
Budget (OMB) designated metropolitan areas. Census tracts in certain
metropolitan areas may also be eligible if they are located at a
significant distance from the major city in the SMA.

**"Rural Populations"** means populations who reside in rural areas.

**"School of Nursing"** means a collegiate, associate degree, or diploma
school of nursing as defined in Section 801 of the Act.

**"Senior High School"** refers to grades nine through twelve or ten
through twelve, depending on the school district.

**"State Governments"** means the governments of any of the several
States of the United States, the District of Columbia, the Commonwealth
of Puerto Rico, any territory or possession of the United States, or any
agency or instrumentality of a State exclusive of local governments. For
purposes of PHS grants, federally recognized Indian tribes are treated
the same way as State governments. State institutions of higher
education and State hospitals are considered nongovernmental
organizations for purposes of this program.

**"Underrepresented Minorities"** means racial and ethnic populations
that are underrepresented in the registered nurse population relative to
the number of individuals who are members of the population involved.
Underrepresented minorities include Black or African American, Hispanic
or Latino, American Indian or Alaska Native, and any Asian or Pacific
Islander group other than Chinese, Filipino, Japanese, Korean, Asian
Indian, or Thai.

**Appendix F**

**NURSING WORKFORCE DIVERSITY PROGRAM Project Synopsis**

The following synopsis of the proposed project will assist the reviewers
and the federal staff in identifying key components of the application.
Please consider placing this checklist at the front of the submitted
application.

Applicant Organization
Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Project Director
Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Project Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Place an "X" in the appropriate box for each item.**

1.  Identify the Type of Educational Program Being Addressed:

-   Associate Degree in Nursing

-   Diploma

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-   Baccalaureate Degree in Nursing

2.  Identify if requesting the following preference:

-   Substantially benefit rural populations

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-   Substantially benefit underserved populations

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```
-   Help meet public health nursing needs in State or local health
    departments

    **It is encouraged that the applicant select and document how they
    met at least one of the preferences listed above.**

3.  Type of Applicant Institution

> Diploma School of Nursing
>
> Community College
>
> 4-yr College/University
>
> Academic Health Center

Long Term Care Facility

> State or Local Govt.

Nursing Center

> AHEC

Health Care Organization

A partnership of a School and a health care facility

Other

4.  Check all Program Participants

    Elementary School Students

    Middle School Students

    High School Students

    High School Graduates

    College Students (Pre-nursing)

    College Students (Nursing majors)

    LPNs/LVNs

    CNAs

    Other
    (Specify)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

    **Appendix G**

    **Recommended Program Table**

**Admissions to the Nursing Program, Total Enrollment, and**

**Graduation by Race/Ethnicity and Disadvantaged Status**

<table style="width:100%;">
<colgroup>
<col style="width: 28%" />
<col style="width: 0%" />
<col style="width: 12%" />
<col style="width: 10%" />
<col style="width: 0%" />
<col style="width: 10%" />
<col style="width: 13%" />
<col style="width: 0%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 15%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2"><h2 id="raceethnicity">Race/Ethnicity </h2></td>
<td colspan="3"><h2 id="admissions-to-school-of-nursing">Admissions to
School of Nursing </h2>
<h2 id="section">10/15/2005</h2></td>
<td colspan="3"><h2 id="total-enrollments-in">Total Enrollments in </h2>
<h2 id="school-of-nursing">School of Nursing </h2>
<h2 id="section-1">10/15/2005</h2></td>
<td colspan="3"><h2 id="graduates">Graduates</h2>
<p><strong>7/1/04-6/30/2005</strong></p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"><p>1<sup>st</sup> Year</p>
<p>Enrollment</p></td>
<td><p>% 1<sup>st</sup> Year</p>
<p>Enrollment</p></td>
<td colspan="2"><h2 id="total">Total</h2>
<p>Enrollment</p></td>
<td><h2 id="total-1">%Total</h2>
<h2 id="enrollment">Enrollment </h2>
<h2 id="section-2"> </h2></td>
<td colspan="3"><p>Number of</p>
<p>Graduates</p></td>
<td><p>%of Total</p>
<p>Graduates</p></td>
</tr>
<tr class="odd">
<td><p>American Indian or</p>
<p>Alaskan Native</p></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td>Asian(Not Underrepresented)</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>Underrepresented Asian Subgroup *</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>Black or African American</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>Hispanic or Latino</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><p>Native Hawaiian or</p>
<p>Other Pacific Islander</p></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>White</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>Other</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><em>TOTAL STUDENTS</em></td>
<td colspan="2"></td>
<td><em>100%</em></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"><em>100%</em></td>
</tr>
<tr class="even">
<td><em>Total # of Non-Disadvantaged Students</em></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"><h2 id="section-3"></h2></td>
<td><h2 id="section-4"> </h2></td>
<td colspan="2"></td>
<td colspan="2"><h2 id="section-5"> </h2></td>
</tr>
<tr class="odd">
<td><em>Total # of Disadvantaged Students</em></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

\* Any Asian other than Chinese, Filipino, Japanese, Korean, Asian
Indian or Thai

**Instructions:**

-   Data for this table should reflect first year students enrolled in
    the undergraduate nursing program, all students enrolled in the
    undergraduate nursing program and students who graduated from the
    nursing program.

-   For "First Year Enrollments" enter the number of students admitted
    into the first year of the nursing program as of October 15, 2005.

-   For "Graduates" enter the number graduating between July 1, 2004 and
    June 30, 2005.

-   Count each student in only one (1) racial/ethnic category.

-   Count students who identify their race/ethnicity as a combination of
    the specified categories and students who identify their
    race/ethnicity as something other than the specified categories in
    the "Other" category.

-   Count international students in the "Other" category. Do not include
    international students in any specific racial/ethnic category.

-   Each student should be counted in either the "Total Disadvantaged"
    or "Total Non-Disadvantaged" category.

> **NOTE: INFORMATION IN THIS TABLE IS REQUESTED FOR ALL STUDENTS IN THE
> NURSING PROGRAM INCLUDING THOSE WHO ARE NOT SUPPORTED BY THE PROJECT**