This application form, Attachment A, is the cover form for the 2021 Addressing COVID-19 Health Disparities Among Racial and Ethnic Minorities in West Virginia funding announcement from the West Virginia Department of Health and Human Resources (DHHR), Bureau for Public Health (BPH). Organizations use it to identify themselves, name the project and county, and describe the project in one or two paragraphs. On FillingPDF you can fill out the form online and download or print the completed PDF; the form and the funding announcement are published by the agency.
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What is Attachment A?
Attachment A - Application Form is the one-page form that an organization completes to apply under the West Virginia Department of Health and Human Resources, Bureau for Public Health (BPH) funding announcement titled 2021 Addressing COVID-19 Health Disparities Among Racial and Ethnic Minorities in West Virginia.
The form collects the basic facts about the applicant and the proposal: project title, applicant organization, contact person, organization address, daytime telephone, fax and email, the county to be served, the population impacted by the grant, the total population reach (the number of people to be served), the grant amount requested, the WV Oasis # and the Duns #. It ends with a space for a brief project description of no more than one or two paragraphs.
It is not the whole application. The form tells the applicant to attach a Project Narrative Form, a Budget Worksheet and other supporting documentation (letters of support). The BPH funding page lists the Application Form, Project Narrative Worksheet and Budget Worksheet as the required forms for this announcement.
The form also carries a warning: failure to provide complete and accurate information may be considered grounds for disqualification, and the BPH may request additional information and may accept or reject any or all proposals, in whole or in part. Do not confuse it with the application forms for the other 2021 BPH announcements listed on the same funding page; this one is headed for the racial and ethnic minorities announcement.
Who needs to file Attachment A?
Organizations that wanted to apply for funding under the BPH's 2021 Addressing COVID-19 Health Disparities Among Racial and Ethnic Minorities in West Virginia announcement completed this form. The form asks for an applicant organization, a contact person and the organization's address, so it is written for organizations rather than individuals.
Applicants had to name the county to be served by the proposed project, the population the grant would affect and the number of people the project would reach.
Applicants also had to attach the Project Narrative Form, the Budget Worksheet and other supporting documentation (letters of support); the Application Form alone was not the full package.
The form is headed for this one announcement. The BPH funding page lists separate 2021 announcements, such as the one for rural areas and the one on vaccination equity, so an applicant to one of those should use the materials posted for that announcement. The BPH funding page also states that there are no current funding announcements and that this one closed on 11/18/2021.
When to file Attachment A
Applications were due by November 18, 2021, by 5:00 p.m. ET. The BPH funding page lists this announcement as closed on 11/18/2021 and says there are no current funding announcements, so the form is useful today mainly as a reference for what the application asked.
Complete the form together with the other required pieces, since the form says to attach the Project Narrative Form, the Budget Worksheet and other supporting documentation (letters of support). An applicant that fails to provide complete and accurate information may be disqualified.
Documents you need
- Project Narrative Form: attach it to the Application Form, as the form instructs.
- Budget Worksheet: attach it to the Application Form, as the form instructs.
- Other supporting documentation, specifically letters of support: attach them with the Application Form, as the form instructs.
How to fill out Attachment A
Enter the project title
In Project Title, write the name of the proposed project for the 2021 Addressing COVID-19 Health Disparities Among Racial and Ethnic Minorities in West Virginia announcement.
Identify the applicant organization
Enter the Applicant Organization and the Contact Person who can answer questions about the application.
Enter the organization's address
Fill in the Address of Organization with City, State and Zip.
Add contact numbers and email
Enter Telephone (Day), Fax and Email for the contact person or organization.
Name the county to be served
Under County to Be Served by Proposed Project, enter the county where the project would operate.
Describe the population and reach
In Population Impacted by Grant, name the group affected. In Total Population Reach, enter the number of people to be served by the proposed project.
Enter the grant amount requested
In Grant Amount Requested, enter the amount you are asking for, consistent with your Budget Worksheet.
Add WV Oasis # and Duns #
Enter your organization's WV Oasis # and Duns # in the two identifier fields.
Write the brief project description
In the description box, summarize the project in no more than one or two paragraphs.
Review and download the completed PDF
Check that every field is complete and accurate, then download or print the completed PDF from FillingPDF. Assemble it with the Project Narrative Form, Budget Worksheet and letters of support, as described under How to submit.
How to submit Attachment A
The form itself prints no mailing address, email address or online portal, so it does not name a submission channel. It states only the deadline: November 18, 2021, by 5:00 p.m. ET.
- Where the announcement lives: the BPH funding page at https://dhhr.wv.gov/bph/funding/Pages/Funding.aspx lists this announcement and its required forms: Application Form, Project Narrative Worksheet and Budget Worksheet.
- What goes with the form: the Project Narrative Form, the Budget Worksheet and other supporting documentation (letters of support).
- Current status: the funding page marks the announcement closed on 11/18/2021 and lists no current funding announcements.
For delivery details of any current opportunity, contact the Bureau for Public Health through the DHHR website. FillingPDF lets you fill out and download the PDF; submission follows the agency's channels, not this site.
Common mistakes to avoid
- Submitting the Application Form without the Project Narrative Form, the Budget Worksheet or the letters of support that the form says to attach.
- Leaving fields incomplete or entering inaccurate information; the form says this may be grounds for disqualification.
- Writing a project description longer than one or two paragraphs when the form asks for a brief description of no more than that.
- Missing the November 18, 2021, 5:00 p.m. ET deadline printed on the form.
- Entering the organization's headquarters county instead of the county to be served by the proposed project.
- Using this form for a different 2021 BPH announcement instead of the one named in its heading.
Frequently asked questions
What is the Attachment A application form from West Virginia BPH?
It is the one-page Application Form for the BPH's 2021 Addressing COVID-19 Health Disparities Among Racial and Ethnic Minorities in West Virginia announcement. It collects applicant details, the county served, population reach, grant amount requested and a short project description.
What do I need to attach to the application form?
The form says to attach a Project Narrative Form, a Budget Worksheet and other supporting documentation (letters of support). The BPH funding page also lists the Application Form, Project Narrative Worksheet and Budget Worksheet as the required forms.
What was the deadline for this application form?
Applications were due by November 18, 2021, by 5:00 p.m. ET. The BPH funding page lists the announcement as closed on 11/18/2021 and says there are no current funding announcements.
How long can the project description be?
The form asks for a brief description of no more than one or two paragraphs. Use it to summarize the project; the Project Narrative Form is a separate attachment.
What happens if I leave information out?
The form states that failure to provide complete and accurate information may be considered grounds for disqualification. It also says the BPH may request additional information and may accept or reject any or all proposals, in whole or in part.
Where do I send the completed application form?
The form prints no address, email or portal, only the deadline. The BPH funding page at dhhr.wv.gov/bph/funding/Pages/Funding.aspx lists the announcement and required forms; contact the Bureau for Public Health for delivery details of any current opportunity.
Can I fill out this application form online?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not affiliated with the West Virginia DHHR, and it does not submit the application; delivery follows the agency's channels.
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