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Community Health Contract Grant Application

Community Health Contract Grant Application

FY 2026.2027 
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  • English (US)
  • Spanish (Latin America)
  • 1
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  • 2
    What area(s) does your organization serve (check all that apply).
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  • 3
    Provide the legal name of the organization, as it appears on your 990. If you have a different DBA or nickname, please add that in the box adjacent to the legal name. State NA if the DBA is not applicable.
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  • 4
    Please add the contact information for the person responsible for the submission and administration of this grant proposal.
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  • 5
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  • 6
    This is the address documents and payments will be mailed.
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 7
    This is the primary address where the Organization provides services.
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 8
    Provide the legal date your organization was founded, and when did your organization begin offering services in the Greater Fallbrook area?
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  • 9
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  • 10
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  • 11
    Be sure your file meets our submission requirements as listed on our website, please limit this section to two pages. Discuss the need for your organization’s activities within the service area of the Fallbrook Regional Health District (FRHD). The Statement of Need must clearly relate to your organization's mission and purpose. It should focus on the people you serve, not organizational needs, and it should be well supported by evidence and trends within your service sector. Identify which social determinants of health are addressed within this need. Include qualitative and quantitative data that support your argument, as well as relevant statistics and research, to demonstrate why this is a need within the District. Using the Social Determinants of Health as the model, provide examples of how your organization’s activities support disease prevention or the promotion of healthy lifestyle behaviors. Briefly describe how your organization aligns with FRHD’s strategic priorities of: Diabetes prevention or management, cardiovascular disease management – i.e., hypertension, obesity, mental health, and basic needs and healthcare access.
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  • 12
    Be sure your file meets our submission requirements as listed on our website, please limit this section to one page. Discuss how the organization's activities are measured for impact. Provide details on the short and or long-term impact of these activities from within the context of the social determinants of health. Include both qualitative and quantitative data that reflect your organization's impact. Be sure to include how this impacts FRHD’s strategic priorities of: Diabetes prevention or management, cardiovascular disease management – i.e., hypertension, obesity, mental health, basic needs and healthcare access.
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  • 13
    Active collaboration is demonstrated by specific ongoing actions that benefit two or more organizations. Explain how this collaboration provides support for your organization. These collaborations may be already established or initiated within the grant cycle. Applications with established or planned collaborations will receive greater consideration. Do not list funders or other financial supporters who are not directly involved in the provision of the service/program.
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  • 14
    What other organizations within the community offer similar programs/services that address the needs outlined in your Statement of Need section? Explain why your organization's provision of services is different from/or compliments offerings from other providers.
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  • 15
    We encourage you to request an amount that reasonably reflects your organization's size, budget, and community impact. With a limited grantmaking budget and a commitment to support as many qualified applicants as possible we ask that you thoughtfully consider your organization's needs and overall context when determining your request. Final grant award amounts may differ from the requested figure.
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  • 16
    Upload your organization's budget. You may include a single page budget narrative to help explain unique aspects of your operations.
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    Max. file size: 10.6MB
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  • 17
    Upload a list of funding partners for the last two years. Grants should be listed by funding entity name, amount awarded and date. Include a separate line that reports the total, by year, for organizational funding support from events and general donations. Donor names do not need to be disclosed.
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  • 18
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  • 19
    List the percentages of your program participants’ ages. Percentages must add up to 100%
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  • 20
    If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write N/A if this question does not apply to your organization.
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  • 21
    List the percentages of your program participants’ gender identification. Percentages must add up to 100%.
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  • 22
    If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write N/A if this question does not apply to your organization.
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  • 23
    List the percentages of your program participants' income limit category - 2025 HUD – AMI Income limits (4 person family). Percentages must add up to 100% for review of these limits visit: https://www.sandiegocounty.gov/content/sdc/sdhcd/rental-assistance/income-limits-ami.html
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  • 24
    If you indicated that you do not collect data on the above question, please provide a rationale as to why that information is not sought. Write N/A if this question does not apply to your organization.
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  • 25
    Where most or at least half of the program can be provided in the participant's primary language.
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  • 26
    Select the one category that best describes your program's participants.
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  • 27
    Please select the methods by which the Organization will acknowledge the District's investment of funding.
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  • 28
    Please explain how the District's name or logo will be promoted. If social media is selected, please identify which platforms your organization utilizes.
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  • 29
    Provide the days and times when site visits can be made to the organization. Note that the site visit should be able to observe service activities when possible.
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  • 30
    Provide the days and times when your organization's Board of Directors meet. If these meetings do not occur on a regular basis, please explain how these meetings are arranged.
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  • 31
    Upload a list of your Board of Directors: including Full Name - First, Last, Board Position, Professional Affiliation/Industry and contact email address.
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    Max. file size: 10.6MB
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  • 32
    Most recent audited financials with management letter. If your agency does not have audited financials, please contact the District. *Please note that audited financials will be required for any agency older than 5 years or with an annual budget over $500,000.
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  • 33
    From the most recent fiscal year end.
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  • 34
    Most recent fiscal year end.
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  • 35
    Checking this box certifies that all information presented in, or attached to, this application is complete and accurate, and that the organization is aware and will comply with the District's grant policies as posted.
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DRAFT FY 2026.2027 Fallbrook Regional Health District Community Health Contract Grant Application
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