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**Application Steps**

1.  Read the Overview and Demonstration Project Selection Criteria for
    the Models of Food Stamp Nutrition Education and Evaluation study.

2.  Send any question you may have about this study to your FNS Regional
    FSNE liaison by August 29, 2008. Questions should be sent via email.

3.  Review FNS replies to project questions on Friday, September 12^th^
    at [http://foodstamp.nal.usda.gov](http://foodstamp.nal.usda.gov/)

4.  Answer the application questions completely and clearly. Consider
    the Project Selection Criteria in preparing the application.

5.  Obtain letters of support from State and local Food Stamp agencies
    indicating that they are aware of your proposed nutrition education
    intervention and approve of it. If State and local Food Stamp
    agencies will play a role in the intervention, their role must be
    described within these letters of support.

6.  Obtain resumes for your project liaison to FNS and all key
    personnel.

7.  Send the completed application, letters of support, and resumes to
    FNS no later than October 15, 2008. The application package should
    be *emailed* to <Hoke.Wilson@fns.usda.gov> with the subject line
    **Demonstration Project Application**

> *OR*
>
> *Faxed* to 703-305-2576. The cover sheet should include the subject
> **Demonstration Project Application**; Attn: Hoke Wilson. Be sure to
> specify the number of pages, including coversheet, in your fax.

8.  Participate in teleconference with FNS technical reviewers if

> additional information or clarification is needed.

**Part I**

For an implementing agency's application to be considered, each
applicant must agree to the following. Checking each box acknowledges
acceptance of these conditions.

*It is understood that as part of the selection process FNS will make
inquiries of State Food Stamp Agency authorities concerning the
financial and program integrity of the FSNE services provided by the
applicant.*

*If selected, our implementing agency and project team agree to
cooperate with the independent, FNS evaluations of both our nutrition
education intervention and our outcome/impact evaluation. Our pledge of
cooperation includes, but is not limited to,*

-    *Providing access to individuals participating in our project's
    nutrition education intervention.*

-    *Assisting with the identification of a control or comparison group
    and facilitating access to individuals in the evaluation control or
    comparison group.*

-    *Attending two meetings at FNS headquarters in Alexandria,
    Virginia.*

-    *Making every effort to maintain the integrity of the FNS impact
    evaluation.*

-    *Entering into agreements with the FNS evaluation contractor from
    whom the \$100,000, 100% Federal incentive payments shall be
    distributed in three installments.*

The remainder of this application form is based upon specific selected
templates as described in the [2009 Food Stamp Nutrition Education Plan
Guidance](http://www.nal.usda.gov/foodstamp/guidance/Final_2009_Guidance.pdf).
The nutrition education intervention projects that are selected as
Models of Food Stamp Nutrition Education and Evaluation will launch
their nutrition education interventions in FY 2010. States should
include their approved nutrition education intervention project as a
part of their FY 2010 State Plan. Note: because most of your information
presented in the project maybe be a projection, it is likely that that
information will need to be updated in your FY 2010 SNAP-ed (FSNE) plan.
For States to be reimbursed at the 50 percent rate for their project's
nutrition education activities, both the nutrition education
intervention and self-evaluation must also be submitted as part of the
State's SNAP-ed (FSNE) Plan for FY2010.

**Part II**

**Appendix A. Template 2: FY 2010 Nutrition Education Plan Proposed
Projects**

Section A. Identifying and Understanding the Target Audience

(7 CFR (272.2 (e)) OMB No. 0584-0083 Expiration 10/31/2010

Please refer to pages 9-14 of the [2009 Food Stamp Nutrition Education
Plan
Guidance](http://www.nal.usda.gov/foodstamp/guidance/Final_2009_Guidance.pdf)
for instructions.

**[Needs Assessment Methodology & Findings]{.smallcaps}**

> **[Needs Assessment Methodology]{.underline}**
>
> *Describe and justify your methodology for assessing the needs of Food
> Stamp Program eligibles in your proposed project area.*

1.  Existing Information (source, content, time frame):

2.  New Information Collection (source and content):

> **[Needs Assessment Findings]{.underline}**

1.  **Describe the Proposed Geographic Location that You Will Serve and
    Your Project Will Impact.**

> *Describe the geographic area your agency serves in terms of size,
> corresponding counties, communities or zip code boundaries. If the
> region your project will impact is a subset of the area your agency
> serves, describe the region your project will impact in terms of size,
> corresponding counties, communities or zip code boundaries.*

2.  **Demographic Characteristics of Food Stamp Program Eligibles in the
    Proposed Geographic Location.**

> *If information is available, discuss race/ethnicity, age, gender,
> family composition, education, and primary language**.** Reference the
> source(s) of any data described.*

  ---------------------------------------------------- ------------------
  **Food Stamp Program (FSP) Participation/Income      **Estimated Number
  Status**                                             within the
                                                       Proposed
                                                       Geographic
                                                       Location**

  Food Stamp participants                              

  Food Stamp eligibles (Income less than or equal to   
  130% of the Federal Poverty Guideline)               

  Income greater than 130% but less than or equal to   
  185% of the Federal Poverty Guideline                

  Income greater than 185% of the Federal Poverty      
  Guideline                                            

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

3.  **Nutrition-Related Behavioral and Lifestyle Characteristics of Food
    Stamp Program Eligibles in the Proposed Geographic Location You
    Serve.**

> *If information is available, discuss implications of dietary and food
> purchasing habits and where and how food stamp eligibles eat, redeem
> food stamp benefits, live, learn, work, and play in your State. Cite
> sources of information.*

4.  **Describe any Sub-Areas of the Proposed Geographic Location Where
    Food Stamp Program Eligibles Are Underserved or Have Not Had Access
    to FSNE Previously.**

5.  **Describe the Implications of Your Needs Assessment and How these
    Findings Are Being Applied to Your Proposed Project.**

**Part III**

**Section B: FSNE Project Goals, Objectives, Activities, Evaluation, and
Collaboration**

**(7 CFR (272.2 (e)) OMB No. 0584-0083 Expiration 10/31/2010**

Refer to pages 14-20 of the [2009 Food Stamp Nutrition Education Plan
Guidance](http://www.nal.usda.gov/foodstamp/guidance/Final_2009_Guidance.pdf)
for instructions.

1.  **[Project Level Goals & Objectives]{.smallcaps}**

*Based on your needs assessment and the current availability of other
nutrition education services, identify your project's goals and
objectives for FSNE. Make sure your objectives are specific, measurable,
appropriate, realistic, and time specific.*

a.  **Project Level Goals**

b.  **Project Level Objectives**

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2.  **[Description of Project/Intervention]{.smallcaps}**

> *For the proposed Project the following information should be
> provided[:]{.smallcaps}*

a.  **Audience.**

> *Specify the project audience category as explained in Section A:
> Identifying and Understanding the Target Audience and other relevant
> characteristics of the proposed audience that will participate in the
> project (e.g., age, gender, etc.).*

b.  **Focus on FSP Eligibles.**

> *Describe how the project will focus education on FSP eligibles.*

c.  **Project Description.** (For each form of education, indicate the
    proposed, key messages you will deliver**)**

> 1\. [Direct Education:]{.underline} *If your proposed project has a
> direct education component, note how you will implement this component
> of the project, giving particular attention to how and where it will
> be delivered, its duration, the projected number of participants, the
> frequency of contacts (number of classes), and key educational
> messages. Indicate the proposed start and end dates for your direct
> education intervention.*
>
> 2\. [Indirect Education:]{.underline} *If your proposed project has an
> indirect education component, note how you will implement this
> component of the project, giving particular attention to the
> communications channels that will be used, the projected number of
> contacts, and the frequency of contacts (e.g. the total number of
> times a contacted FSP eligible will be contacted.). Indicate the
> proposed start and end dates for your indirect education
> intervention.*
>
> 3\. [Social Marketing:]{.underline} *If your proposed project has a
> social marketing component, note how you will implement this component
> of the project, giving particular attention to the communications
> channels that will be used, the projected number of contacts, the
> frequency of contacts (e.g. the number of times a FSP eligible will be
> contacted). Indicate the proposed start and end dates for your social
> marketing intervention.*

d.  **Summary of Research.**

> *Provide a [brief]{.underline} summary of existing research supporting
> the feasibility and effectiveness of your proposed nutrition education
> methods.*

e.  **Modification of Project Methods/Strategies.**

> *Indicate whether or not the proposed project is a modification of
> approaches that have been used previously. Compare your proposed
> approach to those used previously.*

f.  **Use of Existing Educational Materials.**

> *Give the title, author and description of existing educational
> materials that will be used in the delivery of the
> project/intervention. Specify the language(s) in which the materials
> will be used including English. Indicate whether the materials will be
> purchased and justify the need and cost.*

g.  **Development of New Educational Materials.**

> *Identify any new materials that you plan to produce or purchase and
> justify the need and cost.*

h.  **Key Performance Measures/Indicators***.*

> *List the key measures/indicators of implementation, performance or
> outcome/impact that you will capture or collect.*

3.  **[Evaluation Plans]{.smallcaps}**

> *Describe any process and/or outcome or impact assessment evaluation
> planned. As appropriate, please provide:*

-   *A short narrative about any process evaluations you plan to conduct
    in conjunction with your proposed project. Relate what process
    outcomes you will measure (e.g. website "hits", pamphlets
    distributed, recruitment phone calls made, etc.)*

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-   *A narrative about the proposed impact or outcome evaluation that
    will measure nutrition related behavioral change as a result of your
    nutrition education intervention. Describe the proposed
    impact/outcome evaluation's scope, design, measures and data
    collection techniques*

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```
-   If the project has been evaluated previously, note the most recent
    year in which the evaluation was done and describe the results.

**Part IV**

Appendix A. Template 3: FY 2010 Nutrition Education Plan Staffing

**Section C. Proposed Staffing**

(7 CFR (272.2 (d) (2) (i)) OMB No. 0584-0083 Expiration 10/31/2010

See page 20-21of the [2009 Food Stamp Nutrition Education Plan
Guidance](http://www.nal.usda.gov/foodstamp/guidance/Final_2009_Guidance.pdf)
for detailed instructions on completing this template. Provide the
following summary by Food Stamp Nutrition Education (FSNE) project for
all paid staff in the budget. Provide the Full Time Equivalents (FTE),
describe staff responsibilities as they relate to FSNE and note the
costs that you expect to be paid by State and/or Federal funds.

+-----------------------------------+-----------+-----------+----------+
| Project Name:                     |           |           |          |
+-----------------------------------+-----------+-----------+----------+
| **1.Position Title\***            | **2.      | **3.      |          |
|                                   | FTEs\*\*  | De        |          |
|                                   | charged   | scription |          |
|                                   | to FSNE** | of Job    |          |
|                                   |           | Duties**  |          |
+-----------------------------------+-----------+-----------+----------+
| \*Briefly describe the            | \         | P         | Pe       |
| FSNE-related job duties for each  | *\*Attach | ercentage | rcentage |
| position.                         | d         | of FSNE   | of FSNE  |
|                                   | efinition | Time      | Time     |
|                                   | of FTE    | spent on  | spent on |
|                                   | and basis | Ma        | Direct   |
|                                   | for       | nagement/ | FSNE     |
|                                   | calc      | Admin     | Delivery |
|                                   | ulations. | istrative |          |
|                                   |           |           |          |
|                                   |           | Duties    |          |
+-----------------------------------+-----------+-----------+----------+
|                                   |           |           |          |
+-----------------------------------+-----------+-----------+----------+
|                                   |           |           |          |
+-----------------------------------+-----------+-----------+----------+
|                                   |           |           |          |
+-----------------------------------+-----------+-----------+----------+
|                                   |           |           |          |
+-----------------------------------+-----------+-----------+----------+
|                                   |           |           |          |
+-----------------------------------+-----------+-----------+----------+
|                                   |           |           |          |
+-----------------------------------+-----------+-----------+----------+
|                                   |           |           |          |
+-----------------------------------+-----------+-----------+----------+
|                                   |           |           |          |
+-----------------------------------+-----------+-----------+----------+

**Part V**

**Appendix A. Template 4: Nutrition Education Plan Budget Summary for
Sub-Grantees**

Section D. Proposed Budget Summary

OMB No. 0584-0083 Expiration 10/31/2010

See pages 21-22 of the [2009 Food Stamp Nutrition Education Plan
Guidance](http://www.nal.usda.gov/foodstamp/guidance/Final_2009_Guidance.pdf)
for additional instructions on completing this template. Refer to
Appendix C for additional information on allowable costs.

**2. Proposed Project Costs**

> *Provide the State and Federal cost for the proposed project,
> including, at a minimum, the information contained on the following
> table.*

<table>
<colgroup>
<col style="width: 3%" />
<col style="width: 28%" />
<col style="width: 10%" />
<col style="width: 11%" />
<col style="width: 11%" />
<col style="width: 0%" />
<col style="width: 11%" />
<col style="width: 11%" />
<col style="width: 0%" />
<col style="width: 11%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2" rowspan="2"><p> </p>
<p> <strong>Expenses</strong></p></td>
<td colspan="2"><strong>(a) Non-Federal Public Funds</strong></td>
<td><strong>(b) Non-Federal Non-Public Funds</strong></td>
<td colspan="2"><strong>(c) Total Non-Federal Funds (a+b)</strong></td>
<td colspan="2"><strong>(d) Federal Funds</strong></td>
<td><strong>Total Funds (c+d)</strong></td>
</tr>
<tr class="even">
<td><strong>Cash</strong></td>
<td><strong>In-kind Donations</strong></td>
<td colspan="2"><strong>Cash</strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td colspan="2"> </td>
</tr>
<tr class="odd">
<td>1.</td>
<td>Salary/Benefits</td>
<td> </td>
<td> </td>
<td colspan="2"> </td>
<td></td>
<td> </td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>2.</td>
<td>Non-Capital Equipment/Supplies</td>
<td> </td>
<td> </td>
<td colspan="2"> </td>
<td></td>
<td> </td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>3.</td>
<td>Materials</td>
<td> </td>
<td> </td>
<td colspan="2"> </td>
<td></td>
<td> </td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>4.</td>
<td>Travel</td>
<td> </td>
<td> </td>
<td colspan="2"> </td>
<td></td>
<td> </td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>5.</td>
<td>Administrative</td>
<td> </td>
<td> </td>
<td colspan="2"> </td>
<td></td>
<td> </td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>6.</td>
<td>Building/Space</td>
<td> </td>
<td> </td>
<td colspan="2"> </td>
<td></td>
<td> </td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>7.</td>
<td>Maintenance</td>
<td> </td>
<td> </td>
<td colspan="2"> </td>
<td></td>
<td> </td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>8.</td>
<td>Equipment &amp; Other Capital Expenditures</td>
<td> </td>
<td> </td>
<td colspan="2"> </td>
<td></td>
<td> </td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>9.</td>
<td><strong>Total Direct Costs</strong></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>10.</td>
<td>Indirect Cost</td>
<td> </td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>11.</strong></td>
<td><strong>Total Costs</strong></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

**Part VI**

> **Capacity to Support Independent FNS Evaluation**

a.  *Are there persons, schools, counties, or some other appropriate
    unit of study who/that can be randomly assigned to FSNE treatment
    and control groups for evaluation purposes?*

> \_\_\_\_ Yes \_\_\_\_ No
>
> If yes, please elaborate.
>
> []{.mark}
>
> []{.mark}
>
> If no, describe who will be a part of the comparison group? Describe
> how well matched these persons, schools, counties, etc. are to those
> in the project intervention or treatment group? Describe their
> location in relation to the proposed project area.

[]{.mark}

> []{.mark}
>
> []{.mark}
>
> []{.mark}
>
> b\. *Are there any nutrition education programs currently serving
> low-*
>
> *income populations in the proposed project area?* \_\_\_\_ Yes
> \_\_\_\_ No
>
> If yes, please describe the activities, setting and target population.

[]{.mark}

> c\. *If applicable, are there any nutrition education programs
> currently*
>
> *Serving low-income populations in the proposed comparison site?*
>
> \_\_\_\_ Yes \_\_\_\_ No

[]{.mark}

If yes, please describe the activities, setting and target population.