Section 577.150  Application for Grants

a)         The Department shall prepare and make available grant application forms.  These forms will be distributed to eligible applicants that have submitted a valid Notice of Application (see Section 577.130).

b)         Applications shall describe the applicant's proposed methods to achieve the goals specified in the Department's notice of grant opportunity and project requirements (see Sections 577.120 and 577.140).

c)         Applications shall be in two formats, one for new projects and one for the subsequent years of a continuing project.

1)         New project applications shall include the following:

A)        Legal name of the applicant;

B)        Names and titles of all of the applicant's officers and managers;

C)        Applicant's legal address;

D)        General description of the applicant, including its business and business experience;

E)        Applicant's telephone number, fax number, federal employer identification number (FEIN), Illinois Department of Human Rights number, and DUNS (Data Universal Numbering System) number;

F)         Project director's name, phone number and e-mail address;

G)        Detailed description of the project, including a summary of the applicant's plan to address the goals described in the Department's notice of grant opportunity;

H)        Detailed description of the geographic area or special population group to be served by the project, a statement of the special needs of the service area or special population group and a thorough explanation of the manner in which the proposed project would meet those needs;

I)         Detailed list of objectives that the applicant proposes and a time table for their achievement.  These objectives shall be specific, measurable and relevant to the Department's notice of grant opportunity;

J)         A process and measurement criterion that will allow for an objective evaluation of the project's progress in meeting the needs of the service area or special population group described in subsection (c)(1)(H), including appropriate measuring metrics;

K)        A budget listing the total dollar amount needed for the project, including the amount to be provided by the applicant and other funding sources and the amount of funding requested through the grant.  The applicant shall identify all revenue sources and amounts and provide budget estimates, including expenditures for the duration of the project.  The project's budget could include the following costs (if applicable):

i)          Personal services;

ii)         Benefits;

iii)        Travel;

iv)        Commodities/supplies;

v)         Equipment;

vi)        Contractual, consulting and outside services;

vii)       Printing;

viii)      Telecommunications;

ix)        Patient/client care; and

x)         Administrative costs;

L)        A plan and time table for the development of the project's self-sufficiency;

M)       A description of the psychiatric medical student or resident involvement in the project, including numbers participating, level of training, amount of academic time involved, and whether involvement will be a required or an optional experience for the student or resident;

N)        A description of the educational benefits the project would offer students or residents, which would not be available to them without the project;

O)        A description of the project's relationship to other activities and goals of the school or residency program;

P)         For residency program applicants, a summary report for the most recent five-year period of the percentage of graduates who have established psychiatric practices in designated shortage areas in Illinois and, if available, a count of those who have established psychiatric practices in underserved areas of Illinois; and

Q)        The ratio of State support to local support for the project.  Documentation of local support shall be in the form of funds, services, or other resources. (Section 20 of the Act)

2)         Continuing project applications shall include the following:

A)        Legal name of the applicant;

B)        Name and title of the applicant's officers and managers;

C)        Applicant's legal address;

D)        General description of the applicant, including its business and business experience;

E)        Applicant's telephone number, fax number, federal employer identification number (FEIN), Illinois Department of Human Rights number, and DUNS (Data Universal Numbering System) number;

F)         Project director's name and e-mail address;

G)        Progress report on the prior project year's activities, including accomplishments in meeting all stated objectives, impact on needs of the area or population group served, amount of student or resident involvement, and educational benefits achieved;

H)        Summary statement of all changes in plan of action;

I)         Description of all changes in geographic area or special population group being served;

J)         Statement of measurable objectives for the new project year, measured with previously identified metrics;

K)        Work plan and time table to meet the objectives;

L)        Evaluation plan for the new objectives;

M)       Detailed budget with a narrative description, including cost estimates of developing, operating or completing the project; and

N)        For residency program applicants, a report on the psychiatric practice location of the most recent graduates.