Printable Application Templates and Sample Budget Worksheets

Below are links to more than a dozen Printable Application Templates in PDF and two PDF Sample Budget Worksheet examples. The Printable Application Templates provide potential applicants with printable templates that represent the six different NEHA-FDA RFFM grants offered, and the different options within each grant that can be chosen by applicants. Two Sample Budget Worksheets are also included below, representing a Sample Budget Worksheet for a 1-year grant, and one representing a Year 1 budget for a 3-year grant. 

The intent of providing these non-fillable PDF documents is to give applicants the opportunity to see all of the application fields in a printable format for each of the grants they choose to pursue. The actual grant applications for this program must be submitted electronically through the online NEHA-FDA RFFM Grant Program Portal, but the PDFs below can be used to assist jurisdictions as they plan to apply for one or more of the six available grants.

01 Application Template - Track 1 Development Base SA9

02 Application Template - Track 1 Development Base CSIP

03 Application Template - Track 1 Training

04 Application Template - Track 1 Mentorship Mentee

05 Application Template - Track 2 Development Base PHM Risk Factor Study

06 Application Template - Track 2 Development Base PHM Intervention Strategy

07 Application Template - Track 3 M & A Base PHM Level 1

08 Application Template - Track 3 M & A Base PHM Level 2

09 Application Template - Track 2 or 3 Training

10 Application Template - Track 2 or 3 Mentorship Mentee

11 Application Template - Track 2 or 3 Mentorship Mentor

12 Application Template - Track 2 or 3 Special Projects

13 Application Template - Track 2 or 3 Capacity Building

14 Sample Budget Worksheet - 1 Year Grant

15 Sample Budget Worksheet - Year 1 of a 3-Year Grant