Mission Statement:

The North Carolina Division of the American Trauma Society is a statewide, non-profit, voluntary organization dedicated to the prevention of trauma and improvement of trauma care.

Eligible Applicants:

Non-profit organization or governmental entities with the state of North Carolina that qualify for exemption under 501©(3) of the Internal Revenue Code are eligible for funding.

Applications will be reviewed by the Board of the North Carolina Division of the American Trauma Society. Their recommendations regarding approval or denial will be final. Applications will be weighted evenly based on the following areas: meets intent, creativity, can accomplish in time frame, meets eligibility criteria, scope of impact, and justification of need. Several grants (number to be determined by the Executive Committee), not to exceed $1,000.00 each, may be awarded.

The priority of this funding will be on interventional projects, although well-developed research projects may also be funded. Emphasis will also be placed on proposals that include a programmatic approach versus a request for materials. Appropriations will be made only to programs and services that will:

(a) have an impact on the prevention of injury

(b) facilitate public education regarding trauma

(c) promote the improvement of trauma care

(d) contribute to the body of research related to trauma.

The NC ATS will not provide support for salaries or capital construction.

Grantees must appropriately use the NC Division of the ATS logo on materials.

Grantees must expend funds by December 31, 2006. Any funds not expended must be resubmitted to the NC ATS or an approval for extension received.

Grantees are required to submit a detailed Project and Fiscal Accountability Report at the end of the project.

Grantees are required to attend the January 2007 meeting of the NC Division of the ATS and provide a verbal report on the project.

January 26, 2006 – February 28, 2006 Call for Proposals

February 28, 2006 Deadline for grant applications for funding

March 2006 NC Division of the NC ATS to review grant applications for approval/denial

March 27, 2006 Letter to requesting agencies notifying them of approval or denial

April 15, 2006 Funds disbursed to grantees

December 31, 2006 Funds must be expended

January 2007 Report by grantees at NC ATS meeting

Please read the instructions carefully before completing the application form. All grant proposals must be submitted according to the guidelines stated below.

Type or print neatly on the application form. Typing is preferred. You may photocopy the form, scan it or reproduce it on a computer as needed.

Please limit your responses to the spaces provided with the exception of allowances given on the application form.

The application must have an original required signature.

Applications cannot be accepted by fax or email.

The application must be complete in order to be considered.

 

A full application must be received by the NC ATS by the close of the business day on Tuesday,

February 28, 2006.

Dennis A. Taylor, MSN, ACNP

President, NC ATS

Carolinas Medical Center / Trauma Services

P.O. Box 32861

Charlotte, NC 28232-2861

Dennis A. Taylor, MSN, ACNP

dennis.taylor@carolinashealthcare.org

704-355-3723

APPLICANT INFORMATION

Name of Department/Organization:

Mailing Address:

Contact Person:

Phone Number:

Fax Number:

PROPOSAL INFORMATION

1. What is the purpose of your organization and how long has your organization been in existence?

Project Title:

Brief Layman’s Summary: (Summary should be succinct and limited to the space below)

Are there others, locally or nationally, who provide services similar to those for which you are requesting funds?

What populations and how many individuals will directly benefit from any assistance rendered and what impact will this funding have?

FUNDING

Total funding requested? Please itemize how funds will be expended. The intention of the grant is not to fund items such as car seats and bike helmets. (If additional space is needed, please attach). Unless otherwise approved by the NC ATS Executive Committee, funding cannot exceed $1,000.00

If the project will be funded from multiple sources, briefly describe each source.

3. Have you received funding from or are you a participant in:

Safe Communities Coalition/Committee Yes ____ No ____

Safe Kids Coalition/Committee Yes ____ No ____

4. What alternate sources of funding have you sought? Are these requests still pending or

denied?

What sources of funding have previously supported this project or a similar project?

How will the project/program be funded in the future?

If NC ATS funds are not available this year, how will this specifically affect your project?

ADDITIONAL INFORMATION REQUIRED

Please attach verification of 501©(3) status and federal tax identification number.

If funded, provide the name of person/institution and address to make check payable to

______________________________________________________________________

______________________________________________________________________

3. Give a brief description of the background and objectives of your organization as they relate to

the successful accomplishment of the project.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

APPROVALS: (I have reviewed and meet the eligibility requirements established)

Name of person completing application:

Signature: Title/Position:

Agency:

County: _______________________________

Dennis A. Taylor, MSN, ACNP

President, NC Division of the American Trauma Society

Carolinas Medical Center / Trauma Services

P.O. Box 32861

Charlotte, NC 28232-2861

Phone: (704) 355-3723 Email: dennis.taylor@carolinashealthcare.org