HomeMy WebLinkAbout910518.tiff IGUE IN CHAPTER APPLICATION
I MA! OF DIMES BIRTH DEFECTS FOUND, ON No. OR
DUE IN HDQTRS CHAPTER GRANTS APPLICATION GRANT H
OCTOBER 1st (All Entries [Must be Typed)
TO: March of Dimes Birth Defects Foundation —
(Name of Grantor _Chapter)
1325 S. Colorado Boulevard, B-508 Denver CO 80222
Street Address City State Zip
FROM: Weld County Health Department -
(Name of Grantee institution or Agency)
1517 16th Avenue Court Greeley CO 806311
Street Address City State Zip
PURPOSE: Chapter Grant Application
Requested for a two-year period beginning January 1, _149.2 and ending December 31, .1.9.9.3 •
Requested 1/1/92 - 12/31/92 a,/1/93 —12/31/93 Totals
Direct Costs _ $ 3,500 $ 1,500 ' $ 5,000
Indirect Costs $ $ $
Total $ 3,500 $ 1,500 $ 5,000
*Conditional upon review of progress and availability of funds
I have read and hereby agree to conform with the March of Dimes POLICIES AND PROCEDURES
GOVERNING CHAPTER GRANTS and to submit progress and accounting reports as r quired.
.
Name-Degree Glenda Schneider Signature ,a84,7,4 e ,,A.,- e Lr64
Director of Nursing Telephone. (303) 353-0639 2256
Academic Rank/Title Area iNumber Lxt.
•
Dept Community Health Services 521-80-5983
VRoGRAM DZRL•CTOR Social Security No.
Name-Title Randy Gordon, M.D. , M.P.H. Signature ,44.-, tvi---
Director
Dept. Weld County Health Department Telephone (303) 353-0586 2204
DEPT. CHAIRMAN or AGENCY DIRECTOR Area Number hxt.
Name Gordon E. Lacy Signature.�'�/'
Chairman
board of County Commissioners Telephone (303) 356-4000 4200
Title Area Nurtwe Ext.
G 'T AND CO RAC OFFICER DEPUTY CLERK
ATTEST: i / ' 1 GreeleX• CO 80631
9 1St ai�x� Y
_ Stree Address City State Zip
PROGRAM CONDUCTED AT Weld County Health Department
1517 16th avenue Court Greeley CO 80631
Street Address City State Zip
CHFCKS TO BE MADE PAYABLE TO Weld County Health Department
/ 1) Date this application submitted June 12, 1991
l i`;`3
910Jid
i 14 A.,A /7
FIRST-YEAR BUDGET
Grant Period ,All Entries Must Be Typed) Prgm. Dir.
From 1/1/ To 12/31/ . Grant #
•
Institution City State Zip
A. SALARIED PERSONNEL
Hrs/wk Total Salary* Amount
on this Received from Charged to
Name Title of Position Grant All Sources this Grant TOTALS
Jan Carrasco Nurse II 3 $ 1,$63
Rosa Tamez Health Aide 3 $ $ 1,237
•
$ $ $ 3, 100
B. EQUIPMENT - List individually each item and amount over $200
(Office equipment not allowed)
$
$ $ 0
C. EXPENDABLE SUPPLIES - List individually each item and amount
over $100
Teen Advisory Board Meeting Costs $ 500
$
$ $ 500
D. OTHER EXPENSES - List individually each item and amount over $100
Teen Resource Center Supplies $ 500
Marketing/Outreach Costs $ 500
Clinic supplies and mileage $ 400 $ 1,400
DIRECT COSTS $ 5,000
INDIRECT COSTS (Not to exceed 10% of DIRECT COSTS; not allowed for
grants entirely for salary support and/or equipment;
nor may the amount exceed DIRECT COSTS for budget
items other than salaries and/or equipment $ 0
TOTAL AMOUNT REQUESTED $ 5,000
*Indicate salary only if part or entire amount will be paid from this MOD grant.
Now number each sheet, starting with page 1.
BINNT.'I'_7U`:'TIFICATInN followed by ABSTRACT etc. 910519
•
CURT. .ULUM VITAE -- PROFESSIONAL PEt ,NNEL
Lindahl Jade L. 11-4-66 _ Greeley,_ CO
Name Last First Initial Date of Birth Place of Birth
Weld County
GB/GYN Nurse Practitioner. 9/91 Health Dept. Greeley, . CO 80631
Clinical Appointment date of this Institution City State Zip
appointment
N/A
Academic Appointment date of this Institution City State Zip
appointment
Women's Health Care/Community Health Nursing
Specialty ( if any) Board CertiTication (if any) Date
N/A
Medical School Affiliation ( if any) Address City State Zip
N/A Address City State Zip
Other Affiliation ( if any)
BSN University of Northern Colo. Greeley CO From 1984 To 1988
Degree (undergraduate) Institution City State Dates
From To
Degree (graduate) 1k9a stitut nA City State Dates
rbor I��L
OB/GYN Nurse Practitioner Medical Center Torrance • CA From4/91 To 8/91
Specialty Institution • City State Dates
N/A From To
Internship ( if applicable) Institution City State Dates
N/A From To
Residency ( it applicable) Institution City , State Dates
N/A From To
Fellowships--Supervisor Institution City State Dates
N/A • From To
Research Experience Institution City State Dates
List below the titles, location and dates of appointments in medical and related institu-
tions, beginning with the most recent:
Community Health Weld County From 3/gl Tol/92
Nurse II Hea1th Qepar meat Greeley CO
Title institution City State Dates
Community Health Weld County
Nurse I • Health Department Greeley CO From 5/89 To 3/91
Title Institution City State Dates
Staff Nurse Rose Medical Center ' Denver CO From 7/88 To 5/89
Title Institution City State Dates
:Memberships : (List 2 max. ) N/A •
Honors : (List 2 max. ) N/A -
Awards : (List 'l max. ) N/A• -
91.0518
Date: June 1 , 1991
CURR_ JLUM VITAE -- PROFESSIONAL PER. ,NNEL
• Brooklyn
West Ruth • 2/16/43 Pennsylvania
Name Last First Initial Date of Birth Place of Birth
Weld County
Nursing Supervisor . 9/1/89 Health Dept. Greeley CO 80631
Clinical Appointment date of this Institution City State Zip
appointment
N/A
Academic Appointment date of this Institution City State Zip
appointment
Community Health Nursing None
Specialty ( If any) Board Certification ( If any) Date
N/A
Medical School Affiliation ( If any) Address City State Zip
N/A
Other Attiltation ( if any) Address City State Zip
BSN University of Colorado Denver CO From 9/66 To 1/69
Degree (undergraduate) Institution _ City State Dates
N/A From To
Degree (graduate) Institution City State Dates
From To
Specialty Institution • City State Dates
N/A From To
Internship ( if applicable) Institution City State Dates
N/A From To
Residency ( ii applicable) institution City , State Daces
N/A From To
Fellowships--Supervisor Institution City State Dates
N/A From To
Research Experience institution City State Dates
List below the titles, location and dates of appointments in medical and related institu-
tions, beginning with the most recent:
Community Health Weld County
Nurse II H alto Department Greeley CO From 12!88 To 9/b9
Title Institution City State Dates
Community Health Weld County
Nurse I • Health Department Greeley CO From 9/87 To12/88
Title iOrIV Lion City State Dates
Nora ollorado
Staff Nurse II & III Medical Center Greeley CO From12/79 To 9/87
Title Institution City State Dates
;Memberships: (List 2 max. ) Colorado Public Health Association
Centennial Area Health Education Center Board of Directors _
Honors : (List 2 max. ) N/A
Awards: (List '1 max. ) N/A
' Date: June 1, 1991 910 ,
CURL. ,ULUM VITAE -- PROFESSIONAL PE. :NNEL
Yetter Terri I. 1/24/56 Longmont, CO
Name Last First Initial Date of Birth Place of Birth
Weld County
OB/GYN Nurse Practitioner. 9/89 Health Dept. Greeley CO 80631
Clintcal Appointment date of this Institution City State Zip
appointment
In t(itution City State Zip
Academic Appointment date of this sobstetric-Gynecologic
appointment
Nurse Practitioner
Women' s Health Care/Community Health Nursing NAACOG June 1, 1990
Specialty ( if any)
Board Certification ( it any) Date
N/A Address City State Zip
Medical School Atfiliation ( if any)
'N/A City State Zip
Other Attlliation ( it any) Address
University of
BS - Nursing Northern Colorado Greeley CO From 1974 Dates To 1978
Degree (undergraduate) Institution _ City State
N/A From To
Degree (graduate) itns itution City State Dates
Flar�or UCLA
OB/GYN Nurse Practitioner Medical Center Torrance CA From_1/89 To 9/89
Specialty
Institution • City State Dates
N/A From To
Internship ( if applicable) institution City State
Dates
N/A From To _
Residency ( it applicable) Institution City , State Dates
N/A • From To
Fellowships--Supervisor Institution City State
Dates
From To
N/A Dates
Research Experience Institution City State
List below the titles, location and dates of appointments in medical and related institu-
tions , beginning with the most recent:
Community Health �Jel� C11��nt From 1S88 To 1/90
Purse II ea tho UepXrtment Greeley CO
litle Institution City State Dates
Community Health Weld County From 2/86 To 1/88
Nurse I - Health Department Greeley CO
Institution City State Dates
Title North Colorado
_ Staff Nurse Medical Center Greeley CO From paC s8 To 2/86
Title Institution City State
Memberships: (List 2 max. ) NAACOG
Honors : (List 2 max. ) N/A
Awards : (List '1 max. ) N/A _
.l1 V 5 .S
• Date: June 1 , 1991
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l - PROFESSIONAL PERSONNEL
Y: CORK ICU VITAE
L 3-ID-61 DENVER
LESLI Place of Birth
BANGERT Initta Date of Birth
• Last First
Name __�_
I City State Zip
HE date of this Lnstttutton
c`I,ntca Appointment
appointment
ate o this Instttution
City State Ztp
A ca emtc Appointment
appointment
Boar Cecil tcatton i any
Date)
Specta ty t any _
Ad ress
City State-----21p
Me Ic a Scltoo 4 Citation i any GREELEY COLORADO 80631
1517 10th Ave Ct tate JiP
WELD COUNTY HEALTH t any DEPARTMENT ress ity
t iatton t any 9/79 6/85
[ per GREELEY COLORADO From To
UNIVERSITY OF NORTHERN COLORADO Dates
"�T
B.A. City State
Degree un ergs uate
Lnstttutton _ From 9/85 Toh/8�_
GREELEY, COLORADO __�. D
M.AM UNIVERSITY OF NORTHERN COLORADO Ctty state ra uate nstttution
Degree g From T°__ - _.
nstttution City State Daces�r-
Specta ty From To___�.,
—�^ Uatas�
InstituT t�oSri City State
Internship i app ica a To
From ---.—--
Institution Kesi ency iL aQp Ica e City State Dates
From To
Institution
City State Dates
• Fe l°
From To
LaSt1tUCLOn
City State Dates
KesearcR • xpertence
List below the titles,
location and dates of appointments in medical and related institu-
tions ,
beginning with the most recent:
From To
____~
nstttution
City Cate Dates
it a From_ To
Lnstttutton
City State Oates
Tit e From To
lnstttution City State �� Dates
Tit e COLORADO PUBLIC HEALTH
Memberships: (List 2 max. ) NATIONAL WELLNESS ASSOCIATION,
___--
ASSOCIATION ------
•
Honors: (List 2 max. ) _---^-
_ ________�--- ----
Awards: (List 1 max. )_
. _-___________ ��,
6/3/91 �'� I 1.• Date:----------- ---------- - - •----
CURk_ ULUM VITAE -- PROFESSIONAL FEL ,NNEL
Morris Marilyn K. 2-15-47 Greeley, GO
Name Last First Initial Date of Birth Place of Birth
Weld County
Community Health Nurse I . 12/89 Health Department Greeley CO 80631
Clinical Appointment date of this Institution City State Zip
appointment
N/A State Zip
Academtc Appointment date of this Institution City
appointment
Community Health Nursing Board Certiftcatton ( if any) Date
pecialty ( if any}
N/A
Medical School Affiliation ( if any)
Address City State Zip
N/A address City State Zip
Other Affiliation ( if any'University of
BSN Northern Colorado Greeley CO From 1985 To 1987
Degree (undergraduate) Institution _ City State
Daces
N/A From To
Degree (graduate)
Lnstitution City State Dates
N/A From To _
Specialty
lnstttution • City State Dates
N/A From To
Internship ( if applicable) Institution City State
Dates
N/A From To
Residency ( it applicable) institution City , State
Dates
From To
N/A Dates
Fellowships--Supervisor Institution City State
From To
N/A Dates
Research Experience lnstttution City State
List below the titles, location and dates of appointments in medical and related institu-
tions, beginning with the most recent:
North Colorado
Surgical Nurse Medical_ ce From 1988 To 1969
Title Instttution City State Dates
1985 1988
Office/Surgical Nurse Surgical Association Greeley CO From
To
Title
Institution City State Dates
Substitute School Nurse DOD ' Bitburg Germany . From 1983 To 1985
Title
Lnstitution City State Dates
Memberships: (List 2 max. )
Honors: (List 2 max. ) -
Awards : (List -1 max. )_ _ __
Date: June 1 , 1991 q ®��.:6
�.
t�•
CI°
DEPARTMENT OF HEALTH
\ 1517- 16 AVENUE COURT
wilip
GREELEY, COLORADO 80631
C ADMINISTRATION (303)353-0586
O HEALTH PROTECTION (303)353.0635
COMMUNITY HEALTH (303)353.0639
COLORADO
Shawn Hayes
Director of Community Services
March Of Dimes
1325 S. Colorado Blvd. B-5O8
Denver, Colorado 80222
Dear Shawn,
Weld County Health Department would like to submit this Letter of Intent for
funding for fiscal year 1992. Funding is sought to continue the activities
funded for 1991 and additional funding is sought to meet the community' s request
for a school based clinic.
PRESENT PROGRAM
The Teen Advisory Board has been assembled and has met twice. This board has
provided us with suggestions (such as pictures and a wall paper border) to
enhance our clinic area. They soon will be reviewing pamphlets and posters.
The Teen Advisory Board has also begun soliciting artwork regarding teen health
issues from the Junior and Senior High Schools. The group is exploring the need
of starting a teen parent support group.
Outreach has been initiated to all the schools in the county. We are obtaining
costs of advertising in the school papers. We also are offering a series of
health tips to the schools for their use.
The Weld County Community Health Coalition has initiated a sub-committee to
evaluate the needs of teens in the community. One of our nurses is the co-chair
of this sub-committee. The group has set up a series of four community meetings
to determine resources and needs of teens locally. The sub-committee will also
be searching for funding to address the needs identified.
PROPOSED PROGRAM
Our goal is to continue addressing the needs identified in this year's grant.
These goals are: 1)to continue the Teen Advisory Board 2)to continue marketing
and outreach in an effort to get more teens in for health care, and 3) to develop
teen resources such as pamphlets and to continue changes to make our agency more
"teen friendly".
,ifT rr i
Page 2
March 29, 1991
In addition to these goals, we have established a new one for 1992. We now have
a school district in our county requesting that we establish a school based
clinic in their high school. School based clinics have shown great benefits in
other communities. The clinic will provide the following services: blood
pressure screening, height and weight, pregnancy testing and referral,
immunizations, and counseling on teen health issues. We feel very fortunate and
excited to have this opportunity if funding is available. The establishment of
such a clinic will be contingent upon approval of the funding by the Board of
County Commissioners.
JUSTIFICATION
In 1989, 147 of the population in Weld County lived in areas without a health
care provider. Approximately 147 of Weld County residents live in poverty.
There are an estimated 17,296 families with children under age 18 in Weld County.
The unemployment rate for Weld County in 1987 was 8.29, compared to 7.77 for
Colorado. The adolescent fertility rate in Weld County has consistently exceeded
that of Colorado since 1980. Using the GINDEX as a measure of adequacy of
prenatal care, 507 of Weld County residents that delivered in Weld County in 1989
received sub-adequate prenatal care. The 1987 Weld County fertility rates for
13 to 14 year-olds, 15 to 17 year-olds and 18 to 19 year-olds were 2.4, 34.1, and
74.2 respectively. State rates for the same age groups for 1987 were 1.8, 26.8,
and 69.8.
We have been requested by Valley High School in Gilcrest to begin a school based
clinic two afternoons per month including the summer months. This school
district covers several towns and would like services available to teens,
children and adults in the district.
STAFFING
Staff time necessary for outreach and the Teen Advisory Board will come from
current Weld County staff. The Weld County Community Health Coalition will
represent the community in evaluating and addressing health needs. Our adult
volunteer to the Teen Advisory Board will continue to assist us. As of September
1991 we will have a second Women's Health Care Practitioner on staff which will
enhance our ability to serve teens. We also will continue our Adolescent clinic
in the Greeley office. The new Health Educator will be starting in May and will
be available for consultation.
The current responsibilities of our staff do not allow for any additional
increases in work load. Funding is necessary to have staff available to run the
school based clinic.
fir, 1.N
Page 3
March 29, 1991
ESTIMATED COSTS AND FUNDING REQUEST $500
Continuance of meetings and
acknowledgements of the Teen Advisory Board
Continuance of outreach and marketing $500
Supplies: posters, brochures, enhancements of the $500
agency to continue making the area teen friendly
Salary for two clinics per month (RN and Health aide) $3100
Clinic supplies and mileage $400
$5000
Thank you for all of your assistance. Please find attached a copy of last year's
abstract and a request for services from the Valley Schools.
Sincerely,
jd c-/elizZ
Glenda Schneider, R.N.
Director
Community Health Nursing Services
M:. Weld School District RE-1
VA1Li K'1 (I ----
P O Box 156 • Gilcrest, olorado 80623
LaSalle • Gilcrest Telephone(303)737-2494 Office of the Principal
Platteville
March 28, 1991
Randy Gordon, M.D.
1517 16th Avenue Court
Greeley, Colorado 80631
Dear Dr. Gordon:
Please consider this request for the establishment of Weld County Child
and Adult Clinics at Valley High School in Gilcrest. Our request is
predicated upon a demonstrated need for wellness services to our students,
and the children and adults of Gilcrest. As you may know, Valley High
School serves the communities of LaSalle, Gilcrest, and Platteville, as
well as the large rural area surrounding those communities. A high per-
centage of those rural residents are low-income families.
The clinic would be established using the health room facilities at the
high school. We request the clinic be open the first Tuesday of each
month with the following hours:
3:00 p.m. to 4:00 p.m. Student Clinic
4:00 p.m. to 7:00 p.m. Community Clinic for children and adults
We would request that consideration be given to providing the following
clinic services:
- blood tests
- immunizations
- blood pressure checks
- pregnancy testing
Thank you for your time in considering this request. We believe providing
wellness services to our communities and students will improve the quality
of life for people in this part of the county.
Sincerelyy,'
PA)
Weise91_051 ni
ipal
xs
r;� mEMORAnDum
� �
Whip Gordon E. Lacy, Chairman
ra Board of County Commissioners Date June 6, 1991
COLORADO From Jeannie Tacker, Business Manager, Health Department 6) 1
March of Dimes Adolescent Health Services Grant Proposal
Subject:
Enclosed for Board approval is the Weld County Health Department's grant
proposal to the March of Dimes Birth Defects Foundation to increase
utilization of Health Department services by the teenage population of Weld
County. WCHD received funding for a similar project from March of Dimes for
the years 1990 and 1991.
If funded, the grant will allow the Health Department to continue addressing
the health care needs of adolescents in Weld County. This will be
accomplished by: continued interaction with the Teen Advisory Board;
providing educational materials which are suitable for teens; providing
services for teens at the Greeley and Ft. Lupton clinics, the Rodarte
Community Center, and a school-based site in Gilcrest; and increasing our
efforts to market these services throughout the county.
The project period for the grant will be January 1, 1992 through December 31,
1993. The total amount of funding requested from March of Dimes for the two-
year period is $5,000.
If you have any questions, please feel free to contact me at extension 2219.
Enclosures
42,1u:51 is;
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