2022-2023 Prevention and Control of Sexually Transmitted Infections (STI) Request for Application (RFA)
Note: Applications will be accepted andawarded on a rolling basis. Please anticipate 60 days between submission ofapplication and an award notification via email.
Organization Information:
This information will be used for follow-up communications and to develop contracts for successful applicants
Full organization name
Lead application contact
Preferred email
Organizational name
Organization address, city, state, sip+4
Phone number
Organization DUNS/unique entity identifier number
Organization's fiscal year
Fiscal agent
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Activities must fall within at least one of the following categories: Prevention, Testing, and Treatment Required application sections include:
Choose at least one of the three areas
Prevention
Testing
Treatment
Population Served
American Indian population
Pregnant Females/ Partners of pregnant females
STI close contacts
Individuals with a history of STI
Individuals with a history of incarceration or institutionalized
High risk populations (MSM, Multiple partners, IDU, drug use)
HIV positive/ partners of HIV positive individuals
Unstably housed
Age Range 20-49
Other
County served
Pennington
Todd
Minnehaha
Dewey
Oglala Lakota
Other
Clinic Hours
8-5 Monday- Friday
Accept walk-in appointments
Open after 5pm
24/7
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Prevention
Prevention:
Strategy(s) Narrative Describe in detail the proposed strategy(s), how you plan to accomplish the strategy(s), and identify a lead person responsible for each strategy(s). Evidence-based practices are preferred, but innovative promising practices are also eligible with justification.
STI Services
Licensed provider performs a physical examination
Provide necessary transportation for STI clients
Perform outreach (STI testing events/community education & awareness)
STI service promotion/campaign
Prenatal services
Need: Describe the need to implement the strategy(s) in the selected sector and the health disparities experienced. Include supporting state or local data.
Partners/Organizations: List all partners/organizations that will be involved in the strategy(s).
Timeline: Provide a detailed timeline for the strategy(s) within the funding period. If overall goals are anticipated to take longer than the funding period, provide an additional long-term timeline with broad goals and objectives.
Evaluation: Provide a workable evaluation plan describing the strategy(s) and its impact. Include evaluation questions to measure impact.
Testing
Strategy(s) Narrative Describe in detail the proposed strategy(s), how you plan to accomplish the strategy(s), and identify a lead person responsible for each strategy(s). Evidence-based practices are preferred, but innovative promising practices are also eligible with justification.
STI Testing
Rapid Syphilis Testing
Basic STI Testing (Chlamydia, Gonorrhea, and Syphilis)
Expanded STI Testing (Chlamydia, Gonorrhea, Syphilis, and HIV)
Pregnancy Testing
Need: Describe the need to implement the strategy(s) in the selected sector and the health disparities experienced. Include supporting state or local data.
Partners/Organizations: List all partners/organizations that will be involved in the strategy(s).
Timeline: Provide a detailed timeline for the strategy(s) within the funding period. If overall goals are anticipated to take longer than the funding period, provide an additional long-term timeline with broad goals and objectives.
Evaluation: Provide a workable evaluation plan describing the strategy(s) and its impact. Include evaluation questions to measure impact.
Treatment
Strategy(s) Narrative Describe in detail the proposed strategy(s), how you plan to accomplish the strategy(s), and identify a lead person responsible for each strategy(s). Evidence-based practices are preferred, but innovative promising practices are also eligible with justification.
STI treatment for definitive diagnosis
Provide Syphilis Treatment
If providing treatment, select the pricing option your organization can secure. Note: Please include a pricing schedule of medications as an attachment below.
340b
Other significant, comparable discount
No discount
Medication Pricing Schedule
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If you are providing medication, approximately how many individuals will your organization be able treat?
Need: Describe the need to implement the strategy(s) in the selected sector and the health disparities experienced. Include supporting state or local data.
Partners/Organizations: List all partners/organizations that will be involved in the strategy(s).
Timeline: Provide a detailed timeline for the strategy(s) within the funding period. If overall goals are anticipated to take longer than the funding period, provide an additional long-term timeline with broad goals and objectives.
Evaluation: Provide a workable evaluation plan describing the strategy(s) and its impact. Include evaluation questions to measure impact.
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Budget
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Proof Of Organization (W9)
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Proof of Organization (proof of insurance)
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Submit
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