APPLICATION INFORMATION Please indicate two Community Choose two (2) Community Indicate which Guide Strategies you would like to Guide Strategies to cancer screening(s) implement. For each strategy, indicate implement from this column. you will address for whether you plan to implement this each selected for (1) breast cancer, (2), cervical strategy. cancer, or (3) breast and cervical 1. Provider Reminders Breast cancer. Cervical Both 2. Provider Assessment and Breast Feedback Cervical Both 3. Client Reminders Breast Cervical Both 4. Reducing Structural Breast only Barriers 5. Client Education Breast Cervical Both Funds requested $ CURRENT AND PAST WORK WITH BREAST AND CERVICAL CANCER SCREENING (250 words maximum) Please describe your Tribal capacity including past and current experience in working clinic’s on breast and cervical cancer screening. Are you already using any of the recommendations from the Community Guide Strategies listed in section B (e.g. print materials, or provider assessment and feedback)? If so, please describe your experience. WHY ARE YOU INTERESTED IN APPLYING FOR THIS OPPORTUNITY? WHICH COMMUNITY GUIDE STRATEGIES ARE YOU INTERESTED IN IMPLEMENTING? (250 words maximum) Please explain how cancer impacts the Tribal area you serve (if known) and what challenges your Tribal area faces related to cancer screening. Explain why you have chosen these Community Guide Strategies. How do they align with your and your community’s needs capacity?
APPLICATION INFORMATION Please indicate two Community Guide Strategies you would like to implement. For each strategy, indicate whether you plan to implement this for (1) breast cancer, (2), cervical cancer, or (3) breast and cervical cancer. Choose two (2) Community Guide Strategies to implement from this column. Indicate which cancer screening(s) you will address for each selected strategy. 1. Provider Reminders Breast Cervical Both 2. Provider Assessment and Feedback Breast Cervical Both 3. Client Reminders Breast Cervical Both 4. Reducing Structural Barriers Breast only 5. Client Education Breast Cervical Both Funds requested $ CURRENT AND PAST WORK WITH BREAST AND CERVICAL CANCER SCREENING (250 words maximum) Please describe your Tribal clinic’s capacity including past and current experience in working on breast and cervical cancer screening. Are you already using any of the recommendations from the Community Guide Strategies listed in section B (e.g. print materials, or provider assessment and feedback)? If so, please describe your experience. WHY ARE YOU INTERESTED IN APPLYING FOR THIS OPPORTUNITY? WHICH COMMUNITY GUIDE STRATEGIES ARE YOU INTERESTED IN IMPLEMENTING? (250 words maximum) Please explain how cancer impacts the Tribal area you serve (if known) and what challenges your Tribal area faces related to cancer screening. Explain why you have chosen these Community Guide Strategies. How do they align with your community’s needs and your capacity?
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