Include the contact information for the lead organization responsible for this application. You will have the opportunity to list any partners in a subsequent section.




Note: If you answered “no,” your project is ineligible for this funding opportunity.
2. We are considering supporting one or more of the following efforts in our team action plan. Check all that apply.
3. The proposed team action plan intends to advance the following PSE strategies. Check all that apply.
Limit:750 words
LIMIT: 500 words
LIMIT: 1500 words
LIMIT: 1500 words
Limit: 500 words
LIMIT:1500 words
LIMIT: 350 words
Certification
By submitting an application, I certify that I am the duly authorized representative of the organization and that I have reviewed and fully understand the information set forth in the Call for Applications: Planning Grants to Become Healthy HotSpots including the General Guidelines. I further agree to be bound by the requirements in the Call for Application, the General Guidelines for Applicants and Contract Terms and Conditions set forth by CCHHS should the application be accepted and a Contract be offered by CCHHS.
IMPLEMENTATION: After the team action plan is completed, what do you plan to do to ensure its successful implementation? (5 pts)