2023 CPTI Advocacy Training Grant

2023 Advocacy Training Grant Application

Deadline: Friday, January 13, 2023 (Midnight EST)

PROGRAM AND APPLICANT INFORMATION

Pediatric Residency Program: *

Program Director: *

Program Director Email Address: *

Advocacy Program Director (if applicable):

Advocacy Program Director Email Address (if applicable):

Name & Title of Chapter Leader/Partner for Project *

Chapter Leader/Partner Email Address: *

Faculty Information

Are you a member of both the national AAP and state AAP Chapter? *

Yes

Have you ever attended an AAP Legislative Conference or other AAP advocacy training? *

Yes

If yes, what year?

Faculty Name: *

Faculty Title/Position: *

Primary Phone Number *

Primary Email Address *

Resident Information

Are you a member of both the national AAP and state AAP Chapter? *

Yes

Have you ever attended an AAP Legislative Conference or other AAP advocacy training? *

Yes

If yes, what year?

Resident Name: *

Current Year in Residency: *

Primary Phone Number *

Primary Email Address *

APPLICATION QUESTIONS

Identify a current gap in your training program that your project would address. How
will your participation in this grant program benefit your residency program? *

0/250 words

Provide a summary of the educational project you would implement if awarded this grant. Your summary must address the following 4 elements:

Key components of the project (e.g. new activities, curricula enhancements)
Anticipated number of participants (e.g. residents)
Description of what skills participants will learn or practice
Description of how the project will impact participants

0/350 words

State the overall goal and 3-5 specific, measurable objectives for the proposed educational project. (Consider what skills participants will develop, the impact on the residency training program itself, and/or the partnership with the chapter).

Goal: (if your goal exceeds 255 characters, please continue it in the field below) *

Goal (continued)

Objectives:

Describe how you will evaluate your project to determine its success.
(Include quantitative and/or qualitative measures such as pre/post knowledge or attitude changes or
new curricular elements. Ensure the measures are tied to your objectives. Preference will be given to
proposals that include measurable anticipated outcomes.) *

0/250 words

Describe how your AAP Chapter was involved in the development of the proposed
educational project and how you will collaborate on implementing it. *

0/250 words

TIMELINE

All educational project activities must occur between March 29, 2023 and March 31, 2024.
Your timeline should directly reflect the project as described in the application. A final
report is due 60 days after completion of all activities (or by May 31, 2024, whichever
comes first). Refer to the Application Guidelines for additional information.

	Educational Project Activity	Anticipated Completion Date
*	Educational Project Activity	Anticipated Completion Date
*	Educational Project Activity	Anticipated Completion Date
*	Educational Project Activity	Anticipated Completion Date
*	Educational Project Activity	Anticipated Completion Date
*	Educational Project Activity	Anticipated Completion Date
*	Educational Project Activity	Anticipated Completion Date
*	Educational Project Activity	Anticipated Completion Date
*	Educational Project Activity	Anticipated Completion Date

Anticipated completion date for final report (due 60 days after completion of all activities): *

BUDGET

The total amount requested should not exceed $1,000. Budget line items should directly
reflect the project activities as described in the application. Each item should include a
brief description and formula to justify how the amount was determined. Refer to the
Application Guidelines for additional information.

	Activity Expense	Description/Formula	Amount
*	Activity Expense	Description/Formula	Amount
*	Activity Expense	Description/Formula	Amount
*	Activity Expense	Description/Formula	Amount
*	Activity Expense	Description/Formula	Amount
*	Activity Expense	Description/Formula	Amount
*	Activity Expense	Description/Formula	Amount
*	Activity Expense	Description/Formula	Amount
*	Activity Expense	Description/Formula	Amount

Total amount requested: *

Please attach one letter of support from your AAP Chapter *

Please attach one letter of support from your pediatric residency program director *

CERTIFICATION

We attest that both the faculty and resident of our applicant pair will be able to clear our schedules to be fully available to attend the 2023 AAP Advocacy Conference on March 26-28, 2023 in Washington, DC. We will also make ourselves available for the orientation on March 25 (which will occur at either 12pm or 3pm EST).

If you have any questions regarding this application or would like to discuss your project idea, please contact Courtney Day, Manager, Community Health and Partnerships, at cday@aap.org. Applications and attachments are due by Friday, January 13, 2023 (Midnight EST).

Thank you for your interest in the 2023 AAP Advocacy Conference and for being a strong voice for children!