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Mail:
P.O. Box 29214
Washington, DC 20017

Phone:202-470-2732

Email: info@dcbfc.org

DISCLAIMER

The information presented here is not intended to diagnose health problems, breastfeeding problems, or to take the place of professional medical care. If you have persistent breastfeeding problems, or if you have further questions, please consult your health care provider. The DC Breastfeeding Coalition does not share partnership with, or have any vested interest in, any of the businesses that may appear on this site, or sites that may be assessable by links herein contained.

Workplace Lactation Support Mini-Grant Application

All proposals must address the questions below. Please answer each of the following questions completely and concisely.

Section A: (5 points; applications will not be reviewed if a Business Case for Breastfeeding Partner is not named)

Name:

Agency Organization:

Address:

City:

State:

Zip:

*Email Address:

Phone Number:

Fax Number:

Contact information of recommending Business Case for Breastfeeding Partner:

Section B: (20 points)

Describe an overview of your worksite -- discuss key demographic characteristics such as size, type of industry, union status, etc. Describe why a lactation support program is needed within your business and discuss any barriers you've identified that need to be addressed. What do you hope to accomplish if funded? Please outline the general steps you will take to put your plan into place. - (Limit to 300 words)

Section C: (20 points)

1.) Describe the process you will use to assess if your plan has had the effect that you were hoping to achieve. (6 points) - Limit to 200 words



2.) Include a timeline of your activities (based on the September 30, 2010 - November 1, 2010 grant period) to complete your plan. (6 points) Project goals should be set reasonably to allow their completion prior to the end of the grant period. Additional efforts to develop or augment the lactation support program which are not reliant upon completion of the project goals may still be ongoing after grant funds are dispersed. These additional efforts should be mentioned in the final report submitted but will not result in discontinuation or denial of funding.

Timeline (mm/dd)	Activities










3.) Identify how you will meet the in-kind match. (8 points) - Limit to 200 words
An itemized budget is required(see below). DCBFC/MBC funding may not be used for food, staff salaries or travel. We discourage funding for the training of an individual staff member without a mechanism for replication of the training for additional staff.

Budget Format: (10 points)

Provide the following budget information outlining all expenses associated with your program.
Please indicate funding from the DCBFC/MBC Mini-grant funding. DCBFC/MBC Mini-grant funding will not be available for food, personnel or travel. Please be as detailed as possible (i.e., If you want resource material, please list specific items and their costs, etc.). Total funding amount may not exceed $300.

Requested from DCBFC
Item/Expense:	Amount:











Please indicate the in-kind expenses for the project. In-kind funding may be for salary/staff time worked on this project. The total must be greater than or equal to the requested amount to be considered for funding.

Provided through in-kind
Item/Expense:	Amount: