Form 0990-0390 2024 REACH Lark Award Challenge Application

Form Approved

OMB No. 0990-0390

Exp. Date 01/31/2027

2024 REACH Lark Award Challenge Application

Thank you for your interest in applying for the 2024 REACH Lark Galloway-Gilliam Nominations for Advancing Health Equity Challenge (2024 REACH Lark Award Challenge). Please email your completed form to [email protected]. Applicants may also include supplemental documentation references, if applicable. The Challenge will accept applications from April 29, 2024, through June 21, 2024, at 11:59 PM EST.

For this application form, the "applicant" refers to each individual, organization, or community coalition that submits an application or nomination. The "nominee" refers to each individual, organization, or community coalition nominated, whether self-nominated or nominated by a separate applicant.

Demographic and Eligibility Information

1. Please check one:

• I am self-nominating myself or my organization.

• I am nominating an individual other than myself, or an organization/community coalition that I am not currently affiliated with.

2. This nomination is for an:

• Individual

• Organization/Community Coalition

3. Name of Applicant: ____________________________

4. Name of Applicant’s Organization. Please enter “N/A” if not applicable. ________________________________________________________________________

5. Applicant’s E-mail: _______________________________________________

6. Name of nominee (if different from applicant): _______________________________________________

7. Nominee’s website (if the nominee is an organization/community coalition): ________________________________________________

8. Nominee’s affiliation with REACH (select all that apply):

• Currently funded recipient

• Previously funded recipient

• Technical assistance provider to current or former REACH Recipients

• Partner organization or community coalition that has collaborated with current or former REACH recipient

Award Information: Please answer the following questions. Responses to each question should be no more than 300 words. The maximum available points is 60.

1. Community Context and Challenge(s)- The following questions address the challenges of the community in which the nominee works/worked. (10 points)

1. Describe the demographic characteristics of the area/community in which the nominee worked. (5 points)

Scoring will be based on the extent to which the nominee worked to address chronic disease risk factors among one or more of the following groups: Black or African American people, American Indian/ Alaska Native people, Hispanic or Latino people, Asian people, and/or Native Hawaiian/Other Pacific Islander people.

2. Describe the preventable risk factors associated with chronic diseases (hypertension, heart disease, type 2 diabetes, and/or obesity) that the nominee addressed. (5 points)

Scoring will be based on the extent to which the risk factor(s) addressed align with the REACH program’s goals of advancing health equity. Information about past REACH programs can be found here: Past REACH Programs | DNPAO | CDC. Examples of risk factors that align with the goals of the REACH program include poor nutrition, physical inactivity, inadequate access to clinical services, and tobacco use.

3. Describe any relevant additional community characteristics/challenges that will help the judges understand the context of the community in which the nominee worked. (Not scored).

2. Strategies—The following questions pertain to strategies used by the nominee to address the challenge(s) discussed above. (30 points)

   1. Describe the strategies that the nominee used to address challenges and how the nominee’s work aligns with the CDC REACH program’s goals of advancing health equity. (15 points)

Scoring will be based on the extent to which the nominee’s work contributed to developing, implementing, and/or evaluating strategies that were:

• Evidence-based or practice-based? (5 points)

• Culturally tailored, and designed to reduce health inequities (5 points)

• Supportive of policy, systems, and/or environmental change (5 points)

2. Describe how the nominee’s work actively and effectively engaged members of the community and partners across different sectors, such as, but not limited to transportation, healthcare, agriculture, emergency food systems, and faith-based organizations? (15 points)

Scoring will be based on the extent to which the nominee engaged members of the community and partners across different sectors in identifying and implementing strategies.

3. Impact—The following questions pertain to the impact of the nominee’s work on addressing preventable risk factors in a population(s)/group(s) disproportionately affected by chronic diseases. (20 points)

1. Describe the impact of the nominee’s work on addressing preventable risk factors in populations/groups disproportionately affected by chronic diseases. (20 points)

   1. To the extent possible, provide quantitative data that support impact statements (e.g., number of people served by a strategy, number of people reporting a behavior change, health outcome data if available, etc.).

   2. Provide qualitative data from community members, partners, co-workers, etc., (e.g. success stories, testimonials, etc.) that provide insight into the impact of nominee’s work.

Scoring will be based on the extent to which the nominee’s work resulted in progress toward addressing preventable risk factors in the population(s)/group(s) identified in Section 1. While quantitative data is not required, nominations that include quantitative and qualitative data are more likely to paint a more complete picture of the nominee’s contributions and their impact on the community.

Supplementary Materials

Applicants can also submit supplemental materials that demonstrate the nominee’s work and/or impact. Supplemental materials are not to exceed 10 total pages. Examples of supplementary materials include: PDFs of online content, and other forms of written materials e.g., news articles, evaluation reports, or success stories. Please highlight the content you would like to be reviewed in the submitted materials. Will you be submitting additional materials to be considered?

• Yes

• No

If yes, please provide the title of the material(s) and a brief description.

Agreement to Participate:

• Please check the box at the end of this section indicating that you, as the applicant, agree to the following requirements. The applicant refers to each individual or organization/community coalition that submits an application or nomination. The nominee refers to each individual or organization/community coalition who is nominated, including both self-nominated nominees and those nominated by a separate applicant.

  • By participating, the applicant represents, warrants, and agrees that the entry contains accurate information.

  • Applicants and nominees must agree to recognition if selected as an awardee and agree to participate in an interview to develop a success story that describes the intervention(s) that promoted health equity.

    • The awardee may be recognized on CDC’s Division of Nutrition, Physical Activity, and Obesity website or the CDC website generally.

    • Applicants and nominees who are not selected for the award may be asked for permission for CDC to share information about successful interventions that promoted health equity on CDC's Division of Nutrition, Physical Activity, and Obesity website, or the CDC website, and attributed to the applicant or nominee. CDC will obtain approval from the applicant and/or nominee before sharing information about the applicant/nominee publicly.

• By participating

  • Individuals and organizations agree to assume any and all risks related to participating in the award process. Individuals or organizations also agree to waive claims against the federal government and its related entities, except in the case of willful misconduct, when participating in the award process, including claims for injury, death, damage, or loss of property, money, or profits, and including those risks caused by negligence or other causes.

• I agree to the terms above. Date:_____________________

Thank you for Participating!

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