Breast Cancer Alliance, Inc.

15 East Putnam Avenue, No. 414

Greenwich, CT 06830

203 861 0014

 

 

Mission Statement:
The mission of the Breast Cancer Alliance is to fund innovative breast cancer research and to promote breast health through education and outreach. Breast cancer survivors, their friends and health-care professionals are fulfilling this mission.

 

To accomplish this, the Breast Cancer Alliance:

·         Funds a diversified portfolio of breast cancer research

·         Funds Breast Surgery Fellowship programs

·         Provides timely information on breast health and the importance of early detection

·         Supports outreach and case managerial services, education, counseling and mammograms for

underserved and underinsured women in mid to southern Connecticut and Westchester County, New York

 

The term of the Education and Outreach Grant is one year.

 

The program must be directly related to breast cancer services. The Breast Cancer Alliance does not fund:

·         Office supplies

·         Printing costs

·         Travel costs

·         Marketing costs

·         Recruitment costs

 

The Program Director and the authorized grant administration representative are required to sign a Grant Agreement upon accepting the grant.

 

Successful candidates must submit a 1-2 page report documenting progress after six months (July 1, 2010) and a final report within 60 days of the award end date, (March 1, 2011). Failure to submit the mid-term progress report will result in forfeiture of the remaining grant funds.

Any publication associated with the program must list the BCA as a supporter.

Application procedure:
Grant applications will be available on this website May 1, 2009. Please e-mail the completed application (preferably as a pdf)  on or before July 31, 2009.

Our suggestion is to copy and paste the form below into a WORD document, complete it, then convert it to a pdf if possible and submit it to edoutgrants@breastcanceralliance.org.

Please adhere to the format as specified. In addition, please mail one hard copy to the Breast Cancer Alliance.

 

The Board of Directors and the Grants Committee will review the applications. All applications are confidential and are available only to the BCA Board of Directors and BCA Grants Committee.

Applicants will be notified by e-mail in December 2009 of the decision regarding their application. The grant term will begin January 1, 2010. Arrangements for contracts and payment will be made at that time. If any grantee or sponsoring institution fails to adhere to the policies and qualifications listed above, the grant is subject to termination.

Date ___________________

 

 

Name of Agency/ Institution________________________________________

Program Title _________________________________________________________________

_____________________________________________________________________________

 

Amount of Grant Request _______________________________________________________

Address _______________________________________________________

City ______________________ State __________________ Zip __________

Telephone ______________ Fax ________________ Website_____________



Executive Director­______________________________________________________

Telephone ______________ Fax ________________ E-mail _____________

 

Program Director_________________________________________________________

Telephone ______________ Fax ________________ E-mail _____________

Checks made payable to:

Agency/Institution ________________________________________________________

Authorized Institutional Grant Administration Representative______________________

Address __________________________________________________________________

City _______________________ State ___________________ Zip___________________

Telephone _____________________ 

 

 

 

 

 

Program Title________________________________________________

Program Director______________________________________________

 

Please provide the following information. There is no page limit but please number pages consecutively.

A. Description of the program, objectives and measurable goals

 

 

 

B. Relevance of the program to community need

 

 

 

C. Services to underserved or at risk populations

 

 

 

D. Unique aspects of the program

 

 

 

E. Resources, facilities and personnel

 

 

 

F. Evaluation plan

 

 

 

G. Timeline

 

 

 

H. One year itemized budget

 

 

 

I. All other active and pending financial support

 

 

 

J. Current IRS Determination Letter of 501(c)(3) status

 

 

 

 

 

Authorized Institutional Grant Administration Representative 

 

Printed Name and Title__________________________________________      

Signature_____________________­­­­__________       Date_______________

 

Email address____________________________

Applicant’s signature_______________________     Date_______________