Form 1 Center for States Intensive Capacity Building Project

Intensive Capacity Building Project Proposal

1. Date of Completion

2. Agency Name

Agency Lead

3. Agency Address/Phone Number/Email

4. Summary/Overview

Using available resource documents and no more than 500 words, provide a brief statement of the agency needs; a summary of pertinent historical issues within the agency; and agency internal/external pressures, and expectations for capacity building.

5. Project Narrative

1. Describe the issue, need or area of performance that the jurisdiction intends to address with the support of the intensive project, citing all data sources used (500 words or less).

2. Describe the history of jurisdictional attempts at trying to address the problem/issue; include a summary previous technical assistance report outcomes (500 words or less).

3. Describe the theory of change that explains the jurisdiction’s assumptions about how intended and clearly defined outcomes will be achieved (500 words or less).

4. Describe the target population/audience for the intensive project (500 words or less).

5. Describe the proposed improvement strategies (interventions) that the target population(s) are expected to adopt or implement for addressing the identified problem/need. (250 words or less);

Include the proposed role for the intensive capacity building services and explain how these services will support your jurisdictions capacity to implement and sustain the intended changes. Clarify the Center and the jurisdiction’s roles and responsibilities. (750 words or less).

Identify the intended milestones related to intended outcomes. (250 words or less).

6. Identify organizational factors or systemic capacities that are necessary to support successful implementation. Examples may include: staffing resources, funding, service contracts, partnerships, subject matter consultants, peer networking, curriculum developer, trainer etc. (500 words or less).

Identify internal resources the jurisdiction will commit to the intensive project and additional external resources needed. (500 words or less).

7. Briefly describe other system changes that are necessary to support successful project implementation. For example, updating the information management system for tracking, realigning and/or restructuring staffing resources, new policies, braiding funding, legislative changes, etc. (500 words or less).

8. Describe how the proposed project links to state or federal initiatives (e.g. Child and Family Services Review (CFSR) Outcomes, Program Improvement Plan (PIP), Child and Family Services Plan (CFSP), federal plan or jurisdictional court oversight). (500 words or less).

6. Partnerships

Describe other partners and/or stakeholders involved in the change process and their role in the work plan (e.g. contract consultants, internal staff development, new positions for change management, etc.)

Signature of Agency Director/Administrator Date

Signature of Agency Lead for Project Date

Attachments Required:

• Updated Logic Model

• Proposed Intensive Project Work Plan