Menstrual Hygiene Products Accessibility Application 2023-2024

Menstrual Hygiene Products Accessibility Application 2023-2024

Please note, this form will not save works in progress. You may find it useful to compose your answers in a separate document and copy them into the fields below.

Applications must be received by Friday, October 20, 2023, by 11:59 pm

Program Questions:

Jacklyn Thompson, Grant Coordinator

Thompson_J@cde.state.co.us

Sarah Blumenthal, Director of Health Services Office

(303) 866-6779 | Blumenthal_S@cde.state.co.us

Budget/Fiscal Questions:

Anna Friedman, Grants Fiscal Management

(720) 778-1877 | Friedman_A@cde.state.co.us

Application Process Questions:

Mandy Christensen, Grants Program Administration

(303) 957-6217 | Christensen_A@cde.state.co.us

Submission Instructions

Please complete all fields and include any required attachments in the File Upload field at the end of this form.

Part I: Applicant Information

Note: There are specific eligibility requirements for this grant. Please reference the eligibility decision tree and list of eligible applicants on pages 8-10 in the MHPA Request for Applications document.

Local Education Provider (LEP) Organization Name*

For Charter School applicants, please enter your authorizing district or CSI followed by your school’s name. Example: "ABC District - ABC Charter School"

LEP Code

LEP Codes can be accessed on CDE's Frequently Requested Codes webpage. For Charter School applicants, please enter your authorizing district's or CSI's code followed by the school code - "0000-1111"

Mailing Address*

For Charter School applicants, please enter your authorizing district's or CSI's mailing address.

Applicant Type*

Select option below that best describes your organization or authorizer.

Application Contact Information

Note: For Charter School applicants, the Authorized Representative and Fiscal Manager will be contacts from your authorizing district or CSI.

Authorized Representative*

Title*

Telephone*

Phone

E-mail Address*

Program Contact*

Title*

Telephone*

Phone

E-mail Address*

Fiscal Manager*

Telephone*

Phone

E-mail Address*

Part II: Application Request

1) Indicate the number of schools anticipated to be served with these funds:*

2) Indicate the total number of students enrolled in the schools anticipated to be served with these funds:*

3) Indicate the number of restrooms, including gender-neutral restrooms, in the schools to be served with these funds:*

4) Indicate the number of gender-neutral restrooms where hygiene products will be distributed, dispensed, and/or disposed:*

5) Indicate which activities are you requesting funds for (select all that apply):*

Acquiring and distributing menstrual hygiene products at no expense to students.

Installation and maintenance of a dispensing machine(s).

Installation and maintenance of a disposal receptacle(s) for menstrual hygiene products.

6) Indicate the amount of funding you are requesting.*

Please select from the following three options:

$1,000

$2,500

$5,000

Upload Required Documents

Part III: Program Assurances Form

If grant application is approved, funding will not be awarded until all signatures are in place. If submitting Assurances with signatures still pending, please send completed form when available to CompetitiveGrants@cde.state.co.us.

File Upload

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