Fillable 2020 REACH Lark Award Application Form (Office of Citizen Services)

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2020 REACH Lark Award Application Form (Office of Citizen Services)

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2020 REACH Lark Award Application Form
Thank you for your interest in applying for the REACH Lark Galloway-Gilliam Nomination for
Advancing Health Equity (2020 REACH Lark Award). Please email your completed form to
DNPAOPolicy@cdc.gov along with supplemental materials for consideration. CDC will accept
applications through February 14, 2020.
Applicant Information: Please provide the following information.
Please check one:
☐ Individual
☐ Group
Name of individual or group: ______________________________________________________
Organization Name: _____________________________________________________________
Address: _______________________________________________________________________
City: ____________________________ State: ____________ Zip Code: _________________
Email: _________________________________________________________________________
Please provide a written statement of 500 words or less that describes the innovative approach
the individual or group used that led to reduced health disparities in chronic disease.
I
n addition to the 500 word or less written statement, applicants can also submit evidence that
demonstrates that the criteria were met through publications, links to online content, and other
forms of written material not to exceed 15 pages.
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 team who applies—and by participating—
represents, warrants, and agrees that the entry contains accurate information.
• Applicants must agree to recognition as an applicant or awardee, if selected, and agree
to participate in an interview to develop a success story that describes the
intervention(s) that promoted health equity.
o Applicants and the awardee may be recognized on CDC’s Division of Nutrition,
Physical Activity, and Obesity website or the CDC website generally.
o For instance, interventions used by the awardee and certain applicants that
promote health equity may be written into a success story or micro lesson, placed
on CDC’s Division of Nutrition, Physical Activity, and Obesity website, or the CDC
website, and attributed to the applicants.
• By participating
o 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!
Eligibility:
To be eligible for this award, applicants must meet the eligibility requirements located on the
2020 REACH Lark Award Rules webpage
. Applicants will be asked to confirm eligibility upon
submission.
Judging Criteria:
• The extent to which the applicant’s work shows alignment with CDC Office of Minority
Health and Health Equity health equity goals to decrease health disparities, address
social determinants of health, and promote access to high-quality preventive healthcare.
(20 points)
• The extent to which the applicant’s work addressed health issues, including hypertension,
heart disease, type 2 diabetes, and/or obesity, and/or addressed the following
preventable risk behaviors: tobacco use, poor nutrition, or physical inactivity. (20 points)
• The extent to which the applicant’s work demonstrated success in systems improvement
that impacted health outcomes in one or more of the following areas: access to quality
care, education, employment, income, community environment, housing, and public
safety (20 points)
• The extent to which the applicant’s work provided a unique or innovative solution to
improving outcomes for groups most affected by health disparities—specifically, African
Americans/Blacks, American Indians/Alaska Natives, Asian Americans, Hispanic
Americans, and Native Hawaiian/Pacific Islanders (20 points)
• The extent to which the applicant engaged members of the community across different
sectors and successfully demonstrated the development and/or implementation and/or
evaluation of the work within the community related to groups most affected by health
disparities (20 points)
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2020 REACH Lark Award Application Form (Office of Citizen Services)

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Completed 19 July 2020

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