Deadline: March 21, 2014
Please submit completed form to Mark VanKerkhoff
OR mail to:
Kane County Government Center, Bldg. A
Development & Community Services Dept.
Attn: Mark VanKerkhoff
719 Batavia Ave.
Geneva, IL 60134
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Proposal Form
Health Impact Assessment (HIA) Project
The Kane County Planning Cooperative (KCPC) is pleased to offer Kane County municipalities the opportunity to partner with the KCPC
and Chicago Metropolitan Agency for Planning (CMAP) to perform a Health Impact Assessment (HIA). The project will be funded through
CMAP's Local Technical Assistance program. KCPC and CMAP staff will undertake the project with the support of staff from the chosen
What is a Health Impact Assessment?
HIA is an emerging planning tool that uses evidence-based analysis to evaluate how a plan, program, or policy will affect the
overall health of a population. An HIA is designed to inform policy makers before a plan, program, or policy is adopted.
Recommendations are made based on survey results, literature review, analysis of existing data, and stakeholder input.
Learn more about HIA at:
How can HIA be used in my community?
Think about a plan or policy decision that your community will consider in 2014. Would understanding the health impacts of
that plan or policy be helpful in making a decision? For examples on how HIA has been utilized in other communities, please
2. Project Description
Explain how you wish to utilize HIA in your community. Please answer the following questions in your description:
a. What plan, program, or policy will the HIA address?
b. What health indicators do you anticipate the HIA will explore? (e.g. physical safety, obesity, chronic disease,
environmental quality, etc.)
c. How do you believe an HIA will be beneficial during the decision-making process?
You may attach a separate sheet if additional space is needed; please limit your response to 2 pages or less.
1. Applicant and Main Contact
for Application
Organization, name, position, phone
number, e-mail
3. Project Timeline
What is the decision making timeline for the plan, program, or policy that the HIA will address?
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2. (continued)
5. Additional Information
Is there anything else we should know about the proposed project (e.g. political and/or community opposition, staff time concerns,
circumstances surrounding the proposal, etc.)?
4. Stakeholder Involvement
a. Have any partnerships with nonprofit organizations, educational institutions, advocacy groups, or others been identified
for the proposed project?
b. Are there any partnerships that could be beneficial to the project?
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