North Carolina Department of Transportation Bicycle Helmet Initiative - 2021 Call for Applications

Each year in North Carolina, an average of 20 bicyclists are killed while bicycling, one in six bicyclists killed in NC are under the age of 16(1). Children ages 5 to 14 are seen in emergency rooms for bicycle related injuries more than any other sport. Typically, only 45 percent of children usually wear helmets(2). Helmets can reduce the risk of severe brain injuries by 88 percent(3). Funding for the Bicycle Helmet Initiative is made possible through the “Share the Road” specialty license plate. Persons dedicated to bicycle safety in North Carolina have continued to support this initiative that provides funding that makes the Bicycle Helmet Initiative possible for the children in North Carolina that will benefit most from this initiative. (1) NCDOT, Crash Data Tool -Bicycle Injury Query- 2012, (2) Safe KidsWorldwide-www.safekids.org, (3) Helmet Safety Institute –www.helmet.org) Important Web Links: Program Website - https://www.ncdot.gov/initiatives-policies/safety/bicycle-helmets/Pages/default.aspx Program Overview and Guidelines - https://www.ncdot.gov/initiatives-policies/safety/bicycle-helmets/Documents/helmet-initiative-guidelines.pdf NCDHHS Traumatic Brain Injury Program - https://www.ncdhhs.gov/assistance/disability-services/traumatic-brain-injury Timeline: *Call for Applications - December 11, 2020 *Application Submission Deadline – 5:00 pm January 15, 2020 *Award Notification February 16, 2021 *Awardees Receive Helmets By April 30, 2021 *Final Bicycle Event Report Submission Deadline Within 30 Days of Event Note: This application must be completed all at once and cannot be saved and returned to.

Applicant Information

Organization applying for the Bicycle Helmet Initiative award*

Contact Person*

Title*

Best Day-Time Phone Number*

Fax Number

E-mail Address*

Mailing Address*

(PO Boxes & residential addresses are not acceptable)

City*

State*

Zip Code*

I attest that the information given in this application is true to the best of my knowledge; and I as a participant of a bicycle safety and awareness program in my community do promise to make every effort to distribute any awarded helmets to low-income children who would most benefit from this initiative.*

Signature*

Signature Title*

Signature Date*

Application Questionnaire

The Bicycle Helmet Initiative award is specifically provided to make helmets available to low income children. Considering this, how many helmets would you be able to distribute?*

Choose One

Select

Provide your explanation for the requested number of helmets.*

List the community groups you plan to partner with to distribute the helmets:*

Support letters can accompany application packet; partnership is not mandatory for qualification but each letter of support will increase the application’s chances of award. Upload these at the bottom of this application.

List any bicycle safety programs or events you are aware of in your local area*

(include school, police and community programs – Use space to state if no programs exist in your area).

Do you plan on utilizing the North Carolina “Let’s Go NC!” Bicycle and Pedestrian SafetyCurriculum (https://connect.ncdot.gov/projects/BikePed/Pages/LetsGoNC.aspx) as part your helmet distribution efforts?*

Yes

If you answered ‘yes’, specify how you will incorporate the Let’s Go NC! curriculum.

Describe any helmet or bicycle safety initiatives or events you were involved with in the last year.Include information on the target audience and how many individuals were reached:*

(Please limit descriptions to space provided)

Narrative Description

(Please limit descriptions to space provided)

In the space provided, please describe your bicycle safety program and how helmets will be distributed to low income children.*

Documentation Upload

Upload Letters of Support and any other needed documentation.

File Upload

Drag and drop files here or

All groups/organizations that receive helmet awards through the Bicycle Helmet Initiative will be required to forward a brief summary report of their program. This report can be a page or less, but no more than three pages. For all pictures that accompany reports a signed parental consent must be kept on record by the host organization for a period of three years. NCDOT, Division of Bicycle and Pedestrian Transportation reserves the right to use information and images furnished through this initiative at its own discretion.

I understand that a summary report must be submitted 30 days following the bicycle safety event.*

I understand that I/my organization must obtain parental consent for all images.*

Letters of Support Uploaded (Not Required)

Notes

1. Submission of application to the Bicycle Helmet Initiative is not a guarantee of award. 2. PO Boxes and Residential mailing addresses are not acceptable for helmet delivery. These addresses are screened by our helmet vendor and will be not be processed. Only manned commercial addresses should be provided to receive helmets. Please verify the address provided meets this criteria in order to avoid delays.

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