TCA Community AYA Project Grant Application

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1. Applicant Information

Organization/Practice Name (as you would need it listed in the gift agreement):

Practice Type

Please list the type of institution you are applying on behalf of (e.g. academic, community hospital, outpatient clinic, private practice, community provider group)

Street Address

City

State

Zip

First Name

Last Name

Primary Contact Title:

Primary Contact Email:

Phone:

2. Organizational Overview

Briefly describe your setting, population served, and AYA reach (# of AYAs. ages 15-39) served annually). Include relevant key programs/services and project leads. (limit 150 words)

Provide a brief overview of your organization and practice setting. Proposals should be led or co-led by staff working in a community cancer care setting that provides treatment, which can include survivorship and onco-primary care, for any number of patients between the ages of 15-39 with any cancer diagnosis. Key programs and services Brief description of practice setting and population served including: Practice name and structure Location and geographical catchment area Age range served Diagnoses treated Total number of cancer patients served Number of cancer patients ages (15-39) served Names, roles, and contact information of project leaders

3. Needs Statement

Describe the problem or gap affecting AYAs in your setting and why this project matters. Include who will benefit and any relevant data or examples. (limit 150 words)

Clearly describe the need this project will address for AYA patients in your specific cancer care setting. Include: Why this project matters Description of patient or practice-level need or gap at your specific cancer care setting this project addresses Description of target population (diagnoses, ages, or issues within the AYA population), Anticipated number of patients impacted, Any additional information relevant to project scope

4. Project Summary

Summarize what you will do, your project's main goals, and how it connects to one or more AYA Pillars of Care (shown above). (limit 300 words)

Describe the project and how it will directly impact care delivery. Explain how it connects to one or more of the AYA Pillars of Care and reflects TCA’s core vision: That every adolescent and young adult diagnosed with cancer receives the specialized care and support they deserve, no matter where they are treated. Description Goals and objectives

5. Key Activities & Outcomes

Key Activities	Milestones	Metrics / Outcomes
Please use "Add another response" to list additional Key Activities of the project if needed.

6. Evaluation Plan

Describe how success will be measures and data collected (e.g., number of AYAs reached, satisfaction, workflow changes, pre/post surveys). Mention how results will be shared with TCA. (limit 150 words)

Projects must be feasible to complete within a maximum 12-month time frame and should demonstrate a thoughtful approach to real-world implementation. Include activities, timeline, staffing, needed partnerships, resources and tools, and milestones.

7. Budget & Justification

Funds must directly support project activities; no institutional overhead or unrelated research costs are allowed.

Please use the provided EXCEL TEMPLATE and upload it below.

Provide an itemized budget with specific categories of expense: (for example: staffing, supplies project expenses, communications, marketing and publicity relevant to the project) Budget justification- Provide a brief explanation of how each budget item supports the project and why it is necessary.

8. Sustainability Plan

Describe how the project's impact will continue beyond the grant period without ongoing TCA funding. (limit 150 words)

Describe how the project will be sustained beyond the grant period without relying on continued TCA funding. Include the financial and logistical plan for maintaining or expanding the project's impact. Also describe how the information, outcomes, and lessons learned from the project can be shared for greater impact. Awardees will have opportunities to present their projects through TCA’s channels. Describe any additional mechanisms through which you might share what you’ve learned within your site and across other sites in your region or network.

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