Joyce Nichols Community-based Project Fund

Joyce Nichols Memorial Community Grant
Founded in 1992, the North Carolina Academy of Physician Assistants Endowment (NCAPA-E) is a 501(c)(3) nonprofit organization that supports education, research, and healthcare community-building activities for minority populations in North Carolina. Our mission is to promote the future of the physician assistant (PA) profession in North Carolina by supporting philanthropic and research activities by PAs, their employers, foundations, the corporate community, and the general public. The ultimate goal of NCAPA-E is to improve health care in North Carolina.

Purpose: The Joyce Nichols Memorial Community Grant (JNMCG) of the North Carolina Academy of Physician Assistants Endowment is designed to foster knowledge and philanthropy to improve quality healthcare for underserved and under-resourced patient populations at the local level.

Reward: The NCAPA-E will provide up to $2,000 in one-time seed money to a new or ongoing community-based project. This program will support projects that will focus on community-based initiatives through service, education, and/or research. Applications will be considered for projects organized by practicing PAs. PA students in cooperation with faculty sponsors in North Carolina may also apply.

Priority will be given to PAs who are members of the NCAPA.

Areas of interest

The JNMCG strives to support PAs who provide service to their communities or to foster PA-focused research regarding community health care. The proposed community-based projects must meet at least one of the following objectives:

- Service: Projects that will provide direct services to people or communities to improve human conditions in emergency or non-emergency situations.

- Education: Projects that will lead to an educational health intervention that will improve local conditions for individuals or communities.

- Research: Projects that will explore the effectiveness of health-related activities on a local level and/or will investigate community health needs.

Please note: Funds may not be used for computers, production of videos, capital expenses, salaries, and honoraria.

Application Cycle and Deadlines

The JNMCG will consider applications for projects on an annual basis. Applications are reviewed on a rolling basis. Participants are encouraged to submit applications throughout the year.

The JNMCG will consider an application related to emergency issues (disaster relief) at any time. For information on applying for emergency relief contact Suzanne Reich at suzreich@wakehealth.edu.

General Information
Full Name*

PrefixFirst NameLast NameSuffix
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
E-mail*
example@example.com
NCAPA ID:
PA status (check one)*
If applicant is a student, please fill out the following information
Faculty Sponsor's Name
School
Faculty sponsor's email
Faculty sponsor's contact phone

Project Information
Name of Project*
Amount Requested*
Name of organization to whom check should be issued*
Address where check should be issued*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this organization incorporated?*

YesNo
If NOT incorporated, please include a W-9 with the application.

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Project Proposal

Please write a project description addressing each item below. Each heading and attachments MUST be complete in order to have your project considered.
What is the project? Please describe the project in detail. Include your plan, proposed timeline, and how it will be executed.*
What is the likely value to the community?*
How would the JNMCG help with any unmet financial need in your project?*
What are your goals for this project? How will you monitor and measure the success of these outcomes?*
Please provide a full project line item budget listing all expenses for this specific project and any other monetary or nonmonetary support you have received or are receiving for this project. (Please include non-cash donations such as office space, printing, staff, etc.)

Examples of information you may submit
- Support from other sources
  - Government
  - Foundations
  - Corporations
  - United Way/Combined Federal Campaign
  - Individuals
  - Special Events
  - Sale of Items
  - Total monetary and non-monetary support from other sources
The line item budget and projected total cost of the project including other monetary or nonmonetary support received or plan to receive is:
Required Documents

Please attach the following to your proposal
Proof of professional liability insurance. If your program involves direct patient care, you MUST have liability insurance. For projects not involving patient care, this is not required.

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Approved IRB (Institutional Review Board) application. If you are conducting a research project involving patients or learners, an approved IRB application MUST be submitted with your application.

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Support materials. Please provide materials to support your proposal. (Examples: support letters, photos, brochures, websites, social media, annual reports, your resume or curriculum vitae)*

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Certification
I attest that the contents of this grant application are true and accurate. I agree that if I receive a grant, my name, photograph, and any correspondence will be published in professional publications and in new releases.
Signature*

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Signature (Please type your name)*
Date Completed*

MonthDayYear
Signature

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Signature of Community Partner or Supervisor (if applicable)
Date Completed

MonthDayYear
Signature

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Signature of Faculty Sponsor (if applicant is a PA student)
Date Completed

MonthDayYear
Check validation box*
Application Checklist*
Should be Empty:

Joyce Nichols Memorial Community Grant

Project Proposal

Required Documents