Mission Investment Opportunities Program Letter of Intent Score Sheet

Community Based Grants Full Proposal Score Sheet

Instructions: (Please complete this form online if possible) 1. Give the application a score of 0-5 points in each of the twenty areas listed. 0.1 points if you answer the question "no," 2-3 points if you answer the question "somewhat," 4-5 points if you answer "yes." 2. Provide comments under strengths, weaknesses and recommendations.

Reviewer Name Chapter/Division WA State Organization

Project Title Amount $ Value Score Project Description 1. Which priority area does the proposal address? Is the project designed to address the priority area identified? 5 (Give more credit for projects that are specific, focused and targeted) 2. Is the need for the project well established? 5 3. Is the project approach innovative or evidence-based? 5 4. Does the applicant have the capacity to carry out the project? 5 5. Is there a plan for promoting project/March of Dimes visibility? 5 Project Description Score (add #s 1-5) 25 Project Objectives and Activities/Methods 6. Is there a system to effectively monitor progress? 5 7. Are key staff and volunteer responsibilities adequately described? 5 8. Is the staff adequate to achieve the project’s objectives? 5 9. Does the project collaborate with similar programs/organizations (non- 5 duplicate efforts)? Have they included Letters of Collaboration? 10. Are the project objectives well designed to achieve the project goal? 5 11. Are the project objectives measurable, realistic and acheivable? 5 12. Does proposal include at least 1 outcome objective that seeks to change knowledge, behavior or birth outcomes? 5 Project Objectives and Activities/Methods Score (add #s 6-12) 35 Evaluation Plan 13. Is the evaluation plan appropriate to the size and scope of the project? Is an 5 appropriate party responsible for interpreting evaluation results? 14. Is the evaluation designed to determine if project’s outcome objectives have been met? 5 15. Is the evaluation plan well designed to measure the impact of the project on the 5 participants/target audience? Evaluation Plan Score (add #s 13-15) 15 Project Impact 16. Is this project designed to have a significant impact on the chapter grant 5 priority identified? 17. Would this project be a good investment of chapter resources? Is there a plan 5 for sustainability beyond March of Dimes funding? Project Impact (add #s 16-17) 10 Budget 18. Are the budget items appropriate and allowable? 5 19. Does budget justification sufficiently explain the necessity of each line item? 5 20. Is the project cost-effective? Is the cost per client reasonable and appropriate? 5 Budget Score (add #s 18-20) 15

Total Score (Add scores for all shaded rows) 100

SCORING GUIDANCE Score Quality Recommendation Questions/Revisions 90-100 Excellent Definitely should be funded Minor, if any 80-89 Strong Should be considered for funding Minor 70-79 Good Could be considered for funding Will need revisions 60-69 Mediocre Not to be funded without revisions Major <60 Weak Should not be funded Requires rewrite Recommendation ____ Full Funding ____ Partial Funding (at what level?) $______No Funding General Comments

Strengths

Weaknesses

Recommendations/Revisions (if any)