Example Start Up Documentation submitted by grantee

Section A:  The Grant Recipient
Information about the Grant Recipient

Organization Name: County of Multnomah 
Name of Primary Contact: Mr. Steven Bardi
Department/Division: Multnomah County Health Department 
Address: 426 SW Stark Street, 2nd Floor 
Portland, OR  97204-2347

Organization Type of the Primary Grant Recipient
County goverment agency 

Key Personnel

Name Project/Job Title Phone Fax Email
Mr. Steven Bardi Project Director  503-988-4424  503-988-4464  steven.c.bardi@co.multnomah.or.us 
Ms. Colleen Russell Medicaid Eligibility Screening Manager  503-988-3056  503-988-3015  colleen.m.russell@co.multnomah.or.us 
Ms. Jill Daniels SBHC Program Clinical Systems Manager  503-988-4424  503-988-4464  jill.a.daniels@co.multnomah.or.us 
Ms. Valerie Whittlesey SBHC Program Administrator  503-988-4424  503-988-4464  valerie.l.whittlesey@co.multnomah.or.us 
Ms. Consuelo Saragoza Neighborhood Health Division Director  503-988-3674  503-988-3676  consuelo.c.saragoza@co.multnomah.or.us 
Mr. Tim Rowan Information Services Manager  503-988-3056  503-988-3015  tim.n.rowan@co.multnomah.or.us 
Mr. Tom Fronk Strategic Officer  503-988-3674  503-988-3676  tom.r.fronk@co.multnomah.or.us 
Mr. Mike Stark Principal Investigator  503-731-4291  503-731-8602  mike.j.stark@state.or 
Ms. Debbi Patton Network Analyst  503-988-3749  503-988-5009  debbi.a.patton@co.multnomah.or.us 

Section B:  Project Partners
Information about the Project Partners

Partner Organization Name of Primary Contact Organization Type Address Info
(Show All)
Portland Public Schools  Mr. R. Patrick Burk K-12 school or school system  Click Here
Parkrose School District  Mr. Michael Taylor K-12 school or school system  Click Here
David Douglas School District  Mr. Robert Chudek K-12 school or school system  Click Here
Multnomah Education Service District  Ms. Barbara Neely Other education  Click Here
Oregon Community Health Information Network  Mr. Michael Leahy Other nonprofit organization  Click Here
Multnomah County Information Services Division  Mr. Rick Jacobson County goverment agency  Click Here
Outside In  Ms. Kathy Oliver Health Care Organizations  Click Here
National Assembly on School-Based Health Care  Mr. John Schlitt Association  Click Here

Section C:  Project Subrecipients
Information about the Project Subrecipients

Subrecipient Organization Name of Primary Contact Phone Address Info
(Show All)

Section D:  Project Purpose and Outcomes
Information about the overall purpose of the project

Goal Major Goal Minor Goal Not a Goal
Improve quality/efficiency of social services    
Increase employment    
Reduce poverty    
Promote economic/community development    
Improve the quality of (or access to) health care    
Improve the effectiveness of public safety services    
Improve adult training and learning opportunities    
Enhance k-12 educational performance    
Enhance post-secondary educational performance    

Information about each measurable outcome that your project will be using to demonstrate progress toward achieving your community change goals

Project Outcome: Improved utilization of services and programs offered by school-based health centers.
Evidence Measurement of school based health center utilization will be based on the use of specific services provided. Improvement will be measured by comparison of utilization rates before and after implementation of the network technologies. Separately, use of advanced telecommunications technology will be measured by demonstrating the numbers of hits to the web site and the numbers of new students who access the web site. Utilization, defined as how often students are using SBHC and its services, will be measured as accessed by use of advanced telecommunications technology and compared to utilization of services accessed through traditional means. Specifically, we propose collecting utilization information in order to: Assess the numbers and demographic characteristics of students who access SBHC. Assess the numbers of services which are used by students accessing SBHC as shown by the dates of the visits and reasons for each visit; measure the increase in use of the following specific services: A. immunization programs, including the Hepatitis B, measles, mumps, and rubella, and tetanus and diphtheria B. Health guidance in the areas of tobacco and substance use, dental health, injury prevention, exercise, growth and development, and nutrition; C. Mental health services as provided by the mental health consultant (MHC) including diagnostic evaluations, therapy, crisis management, and community referrals related to issues such as depression, school performance, stress, and self esteem; D. Counseling on violence and safety issues; E. Age-appropriate reproductive health services ranging from education and counseling to annual reproductive health examination and birth control prescriptions; F. HIV counseling and testing G. Diagnosis and treatment of STDs.  
Project Outcome: Increased student participation in the design and implementation of the school-based health services.
Evidence During the formative stages of the project, the project evaluator will conduct interviews with students who are serving to assist in the design and implementation of the project. In these interviews data will be collected about students’ perceptions of their ideas being listened to and the extent of their contribution to project development and implementation. The evaluator will also solicit students’ sense of satisfaction with the process of project design and implementation. In addition, interviews will be conducted with these same students during the first project year and once each year thereafter as the project progresses. The evaluator would also participate in the meetings in which student input is solicited, to assist in guiding discussions as well as focusing responses in order to assimilate information gathered in a way that could be measured and later analyzed.  

Section E:  Characteristics of Project End Users and Beneficiaries

The geographic distribution of the project's intended end users
  In a single city, town, or county 

The geographic distribution of the project's intended indirect beneficiaries
  In a single city, town, or county 

Congressional District in which the grant recipient organization is located

The population characteristics of the area(s) affected by your project
  Predominately urban (communities of 25,000 or more) 

All direct end users who will be using the project's equipment or resources
Disadvantaged or underserved populations (specify) under-insured and un-insured students/youth 
Providers of a community service (specify) health care providers 
Consumers of a community service (specify) students/youth 
General public or community at large (specify) any youth that has access to the Internet 
Other (specify) public health officials 

All categories of people who will be indirect beneficiaries of the project's equipment or resources
Disadvantaged or underserved populations (specify) family members of students/youth 
Providers of a community service (specify) enhance overall safety net provider network 
Consumers of a community service (specify) youth receiving services from community organizations 
  General public or community at large (specify)  

Section F:  Project Implementation

Activity / Milestone: Anticipated Completion Date:
Recruit and hire Technical Coordinator and Health Educator.   12 / 2001
Finalize the project evaluation plan.   01 / 2002
Plan and design layout of the WAN.   03 / 2002
Collect and organize baseline client satisfaction data.   03 / 2002
Negotiate agreements for access to network equipment at school sites.   04 / 2002
Initiate the website planning process.   04 / 2002
Purchase, install and test WAN equipment.   06 / 2002
Establish connention with AT&T Broadband Service.  07 / 2002
Initiate the web page design process.  07 / 2002
Initiate the collection and analysis of evaluation data.  07 / 2002
Activate the web page in two phases.   08 / 2002
Conduct an assessment of school-based staff to determine the extent and intensity of their training needs.   08 / 2002
Create and integrate databases associated with clinic operations into the practice management system.   02 / 2003
Assure project implementation.   09 / 2004
Convene “Student Empowerment Team."  09 / 2004
Convene "Project Advisory Team.”   09 / 2004
Coordinate activities with project partners and contractors.   09 / 2004
Near-term and long-term maintenance services are in place.  09 / 2004
Design and initiate an advertising and promotion campaign.   09 / 2004
Secure Webmaster for ongoing site maintenance.  09 / 2004
Secure on-going training and technical support for staff.  09 / 2004
Technical Coordinator and Health Educator serve as in-house experts for practice management system.  09 / 2004
Project Director and evaluator will attend the National Assembly of School-Based Health Centers to present project.   06 / 2005

Section G:  Project Evaluation

The party with primary responsibility for conducting the project's evaluation

  Project staff  
An outside individual or group (specify) Program Design and Evaluation Services 
  Combination of project staff and an outside individual or group (specify)  

The activities the project will be using to assess its implementation, effectiveness, success, and impact
  Surveys (e.g., of staff associated with the project)
User satisfaction surveys
  Site visits/case studies
  Participant observation
Focus groups
  Document review
Website monitoring
Monitoring of information requests
Tabulated information from existing databases (e.g., crime statistics)
  Other (specify):   

Section H:  Other

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National Telecommunications and Information Administration
Office of Telecommunications and Information Applications


Form Approved
OMB NO #0660-0015
Expiration Date: 03/31/2005