Section 655.50  Application Content and Process

a)         Applications for grants under this authority shall be made in the format specified in the "Application and Plan for Health Services Grant" (Form EBA 1, available from the Department of Public Health, 535 West Jefferson, Springfield, Illinois 62706).

b)         Applications shall include a program narrative which incorporates:

1)         An identification of the incidence of problem pregnancy and related problems in the area to be served by the project;

2)         A description of the economic conditions and income level in the geographic area to be served;

3)         A description of existing problem pregnancy-related services including where, how, by whom and to whom they are provided and the extent to which they are coordinated in the geographic area to be served;

4)         A description of major unmet needs for services for those persons at risk of initial or repeat problem pregnancies, the number of persons currently served in the area and the number of persons not being served in the area;

5)         A description of the core services to be included in the project or provided by the grantee, to whom they will be provided, how they will be linked, and their source of funding, to include some, but not necessarily all, of the following:

A)        Health and Mental Health Counseling

B)        Vocational Counseling

C)        Education services which supplement regular school programs to help prevent adolescent pregnancy and to assist pregnant adolescents and adolescent parents to remain in school or to continue their education

D)        Primary and Preventive Health Services including Pre- and Post-Natal Care

E)        Nutrition Services and Nutrition Information and Counseling

F)         social services;

6)         A description of how those persons needing services other than those provided directly by the grantee will be identified and how access and appropriate referral to those services will be provided;

7)         A description of the fee schedule, if any, to be used for any services provided directly by the grantee and the method by which it was derived;

8)         A description of all the services and activities to be linked, the results expected from the provision of such services and activities, and a description of the procedures to be used for evaluating those results;

9)         A description of the administrative structure of the agency or organization and its staff, including curriculum vitae of professional staff (including volunteer staff) of the agency who will be providing project services;

10)         Policies and procedures manual of agency; and

11)         Written agreements with service providers and agencies with which the project will be linked.

c)         A detailed budget shall be submitted on the forms described above and shall include all information and signatures required in the instructions for their completion.

d)         Applications for continuation of funding in subsequent years shall include a detailed budget, a performance report, and a plan of activities for the new project year.  Continuation applications shall be submitted to the Department no later than April 1 of each year.