Attachment A - Application Form is the grant application form of the West Virginia Department of Health and Human Resources (DHHR), Bureau for Public Health, for its COVID-19 Vaccination Equity and Prioritizing Populations Disproportionately Affected by COVID-19 funding announcement. An applicant organization completes it and sends it to the Office of Epidemiology Prevention Services (OEPS) with the other required forms. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original is published by the agency, whose funding page lists this announcement as closed on 11/18/2021.
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What is Attachment A?
Attachment A - Application Form is the one-page form that an applicant organization completes to apply for grant funding under the West Virginia Department of Health and Human Resources (DHHR) Bureau for Public Health's COVID-19 Vaccination Equity and Prioritizing Populations Disproportionately Affected by COVID-19 funding announcement.
The form is issued by the Bureau for Public Health's Office of Epidemiology Prevention Services (OEPS). It identifies the applicant and the proposal: project title, applicant organization, contact person, address, daytime telephone, fax, email, county to be served, grant amount requested, WV Oasis # and Duns #, plus a brief description of the project of no more than one or two paragraphs.
It is not the whole application. The form lists what must accompany it: a Project Narrative Form, a Budget Worksheet, Supporting Documentation (Letters of Support), and any other supplemental information the applicant wishes to include, such as graphs or charts. The agency's funding page names the same set of required forms for this announcement: Application Form, Project Narrative Worksheet and Budget Worksheet.
The form warns that failure to provide complete and accurate information may be considered grounds for disqualification, and that OEPS may request additional information and may accept or reject any or all proposals, in whole or in part. The agency's funding page lists this announcement as closed on 11/18/2021 and states that there are no current funding announcements.
Who needs to file Attachment A?
Organizations applying for grant funding under the Bureau for Public Health's COVID-19 Vaccination Equity and Prioritizing Populations Disproportionately Affected by COVID-19 announcement complete this form. It is written for an applicant organization that names a contact person, states the county it will serve and requests a specific grant amount for a project. The form also asks for the organization's WV Oasis # and Duns #.
The form prints no eligibility criteria of its own and names no one who is excluded, so check the agency's funding announcement for those rules. It does not describe signatures or representatives.
Anyone looking for open funding should know that the agency's funding page lists this announcement as closed on 11/18/2021 and says there are no current funding announcements. The form is therefore useful mainly as a reference for what the application asked, or for a future announcement that uses the same form.
When to file Attachment A
The form states that applications must be emailed no later than November 18, 2021, at 5:00 p.m. ET. The agency's funding page lists the COVID-19 Vaccination Equity & Prioritizing Populations Disproportionately Affected by COVID-19 announcement as closed on 11/18/2021 and says there are no current funding announcements, so that deadline has passed.
The form sets no other timing. It is submitted at the same time as the attachments it lists: the Project Narrative Form, the Budget Worksheet, Supporting Documentation (Letters of Support) and any other supplemental information. No processing time or notification date is printed on it.
Documents you need
- Project Narrative Form: the form says to attach it to the application; the agency's funding page calls it the Project Narrative Worksheet and lists it as a required form.
- Budget Worksheet: the form says to attach it, and the agency's funding page lists it as a required form for this announcement.
- Supporting Documentation (Letters of Support): the form lists it among the items to attach.
- Other Supplemental Information You Wish to Include (Graphs, Charts, etc.): optional, attached only if you wish to add it.
How to fill out Attachment A
Enter the project title
Write the title of your project on the Project Title line at the top, below the COVID-19 Vaccination Equity heading.
Name the applicant organization
Enter the organization's name on Applicant Organization and the person OEPS should reach on Contact Person.
Enter the organization's address
Fill in Address of Organization, then City, State and Zip.
Add telephone, fax and email
Enter a daytime number on Telephone (Day), then Fax and Email. Use an email address you check, since OEPS may request additional information.
State the county to be served
Write the county your project will serve on County to Be Served.
Enter the grant amount requested
On Grant Amount Requested, enter the amount your organization is requesting, matching your Budget Worksheet.
Enter WV Oasis # and Duns #
Fill in WV Oasis # and Duns # with your organization's identification numbers.
Describe the project briefly
Under the description prompt, write a brief description of your project in no more than one or two paragraphs.
Prepare the required attachments
Gather the Project Narrative Form, Budget Worksheet, Supporting Documentation (Letters of Support) and any other supplemental information you wish to include.
Review and download the completed PDF
Check that every line is complete and accurate, then download or print the completed PDF from FillingPDF and send it with the attachments as described under How to submit.
How to submit Attachment A
The form names one channel: email.
- Email: send the completed application to [email protected] no later than November 18, 2021, at 5:00 p.m. ET.
- Attachments: the form asks you to attach the Project Narrative Form, the Budget Worksheet, Supporting Documentation (Letters of Support) and any other supplemental information you wish to include, such as graphs or charts.
The form gives no mailing address, portal or in-person option, and it states no fee. OEPS may request additional information from applicants after receipt. The agency's funding page is at https://dhhr.wv.gov/bph/funding/Pages/Funding.aspx. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Leaving fields blank or entering inaccurate information; the form says failure to provide complete and accurate information may be grounds for disqualification.
- Emailing the application after November 18, 2021, 5:00 p.m. ET, the deadline printed on the form.
- Sending the form without the Project Narrative Form and the Budget Worksheet, which the form says to attach.
- Writing a project description longer than the one or two paragraphs the form asks for.
- Sending the application by a channel other than email, or to an address other than [email protected].
- Omitting the county to be served, the grant amount requested, or the WV Oasis # and Duns # lines.
- Assuming the form alone is the application and leaving out Supporting Documentation (Letters of Support).
Frequently asked questions
What is the Attachment A - Application Form?
It is the one-page application form of the West Virginia Bureau for Public Health, issued through its Office of Epidemiology Prevention Services (OEPS), for the COVID-19 Vaccination Equity and Prioritizing Populations Disproportionately Affected by COVID-19 funding announcement. It identifies the applicant, the project and the grant amount requested.
Is the deadline for this application form still open?
No. The form says applications had to be emailed by November 18, 2021, at 5:00 p.m. ET, and the agency's funding page lists the announcement as closed on 11/18/2021. The page also says there are no current funding announcements.
Where do I email the application form?
Email it to [email protected]. The form gives this as the only way to submit and prints no mailing address, portal or in-person option. Include the attachments the form lists with your email.
What do I attach to the application form?
The form says to attach a Project Narrative Form, a Budget Worksheet, Supporting Documentation (Letters of Support), and any other supplemental information you wish to include, such as graphs or charts. The agency's funding page lists the Application Form, Project Narrative Worksheet and Budget Worksheet as required forms.
What information does the Attachment A application form ask for?
Project title, applicant organization, contact person, organization address, daytime telephone, fax, email, county to be served, grant amount requested, WV Oasis # and Duns #, and a brief project description of no more than one or two paragraphs.
What happens if my application is incomplete?
The form says failure to provide complete and accurate information may be considered grounds for disqualification. It also says OEPS may request additional information from applicants and may accept or reject any or all proposals, in whole or in part.
Can I fill out the Attachment A application form online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not connected to the West Virginia DHHR, and does not send applications; you submit by email through the agency's channel.
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