The following are examples of supporting documentation required for an AHEI Grant application
SAMPLE APPLICATION
Redacted for publication
AHEI Grant Application 2025
Timestamp: 2/28/2025 18:42:08
Name of Organization: Access-For-All
Organization Contact Name: Jasmine Almeida
Website/Social Media Links:
Program Name/Project Name: Mobile Retina Clinic
Description of Program/Project (250 words): The Mobile Retina Clinic (MRC) was
established in May 2024 to raise awareness about the importance of vision health and to encourage regular screening for early signs of retinal disease. The MRC team travels to community locations, including Active Aging Centers, senior living facilities, health fairs, and community gatherings, to offer educational information and no-cost retinal screening. We have conducted 31 MRCs and screened over 500 individuals for retinal diseases. Among those screened, 30% showed signs of retinal disease, and nearly 45% had not had a retinal exam at least in the past two years. Over 70% resided in zip codes at or below the poverty line, underscoring the need for our services to provide access to eye care for all people. Individuals identified with retinal disease were followed up to recommend visiting their ophthalmologist or to visit Erie Retina Research (ERR), our community partner focusing on ophthalmic clinical trials, for no-cost follow-up screening. The essence of MRC is to educate participants on the value of early detection of ocular diseases and employing strategies to prevent progression. Dr. David Almeida, an ophthalmologist and vitreoretinal surgeon at ERR, has partnered with Access-For-All throughout this project to evaluate retinal images obtained from MRC screenings and host educational sessions at various community locations to spread awareness of strategies for preventing or delaying vision loss. We are aiming to conduct nearly 48 MRC events in 2025. Funding from the Alliance Health Education Initiative will support eye wellness kits and educational materials distributed at these events.
What are the Program/Project objectives?
"1. Provide a short educational session and vision health handouts and wellness kits to up to 750 individuals in communities surrounding Erie, Pennsylvania. In 2024, we provided retinal screening and educational materials on eye health to more than 500 individuals surrounding the Erie community in a 6-month time frame.
2. Conduct educational events at local community locations, such as Active Aging Centers, in which Dr. Almeida or another member of the MRC team will give an educational session on an aspect of vision health, such as aging eyes, retinal disease, or tools for improved vision, and host a question-and-answer session for participants.
3. Provide retinal screens for participants to identify signs of ocular disease and offer customized follow-up recommendations."
What are the Program/Project outcomes?
"1. Community members who are part of historically marginalized, lower socioeconomic status, and/or rural communities will receive easy-to-understand vision health education to understand the importance of regular vision screenings and where they can access these resources.
2. Question-and-answer and longer educational sessions hosted by Dr. Almeida will allow participants to attend particular events based on their vision health interests and to ask specific questions about a particular topic, leaving them empowered and with materials and wellness items pertaining to the topic of discussion.
3. Identify signs of ocular disease in participants through rapid retina screening so that participants will understand the importance of receiving in-depth vision screening, adapting their lifestyle to prevent disease progression, and accessing tools to maintain independence."
How many people will be served? Up to 750
Number of volunteers who will participate in this Program/Project: 0
Does your organization receive funding from other sources/endowment? If so, please identify those sources: "Erie Retina Research – Personnel wages for MRC staff are supported by Erie Retina Research for the Mobile Retina Clinic project.
Allegheny College (conditionally approved) – Up to 5 pre-health student interns from Allegheny College will help facilitate the MRC through an 8-week paid internship period, with their wages supported by Allegheny College.
Erie Insurance Charitable Giving – Erie Insurance provided support to purchase a handheld retina screening device for the Mobile Retina Clinic.
Pennsylvania Medical Society (PAMED) – The PAMED Innovation Grant supports the purchase of a van for staff and patient transportation, follow-up transportation services for participants, and other clinic equipment, including a portable dark room, 2 laptops, and an iPad.
Erie Community Foundation (ECF) – The ECF Helping Today Grant supports Access-For-All’s Low Vision Clinic, which provides specialized low vision exams and low vision devices at no cost to patients with profound vision loss."
Will there be matching funds for this Program/Project? If yes, please identify those partners:
As described in the previous prompt and outlined in the detailed project budget, funding and in-kind support from Erie Retina Research, Allegheny College, Erie Insurance Charitable Giving, and the Pennsylvania Medical Society, totaling $141,612, support Mobile Retina Clinic operations.
"Active Aging Centers, senior living facilities, libraries, local health fairs, community-wide events (e.g. Hispanic Heritage Month celebration) – The MRC partners with and visits these organizations, among others, to host our events. The target of this collaboration is to overcome barriers to medical care by meeting individuals in convenient and accessible locations.
Erie Retina Research – Dr. David Almeida and his team at Erie Retina Research assist in hosting and overseeing MRC events and following up with individuals for potential eligibility for ophthalmic clinical trials at no cost to participants.
Allegheny College – Allegheny College hosts a Community-Based Research program in which the College covers wages for up to 5 undergraduate students to intern with a local organization for 8 weeks throughout the summer. Student interns will be assisting with MRC operations and will be trained to provide vision health education to MRC participants and image them using the handheld retina camera.
The Sight Center of NWPA – The Sight Center is a nonprofit organization in Erie, Pennsylvania, with a mission of preventing blindness through vision rehabilitation services. Access-For-All also hosts a Low Vision Clinic at The Sight Center for individuals with irreversible, profound vision loss. We will be able to offer referrals to The Sight Center or Low Vision Clinic services for those in need."
What is the amount of funding requested? $2,458
If the full amount is not awarded, will the Program/Project still move forward? If yes, what limitations will be placed on the Program/Project? The basic concept of the MRC project will continue without the full award thanks to funding from donor organizations, as the project relies completely on external funding. However, these funds have strict spending requirements, and the specific educational components of the MRC will be limited to verbal presentations without wellness kit handouts and high-quality pamphlets in the absence of support from Alliance Health Education Initiative.
How will you publicize your connection to AHEI? "Acknowledgement on written materials shared with attendees at Mobile Retina Clinics – As we develop pamphlets and wellness kits, we will recognize Alliance Health Education Initiative on these materials in each kit by including the logo and written recognition.
Acknowledgement via a placard placed at each Mobile Retina Clinic – We will print a placard that will be placed on the table at each MRC to recognize contributions from the Alliance Health Education Initiative.
Flyer advertisement recognition – We will include the Alliance Health Education Initiative logo and a message of recognition on our digital and printed flyer advertisements."
Organization Federal Tax ID of any partner organization if applicable: 93-4824755
Letter of support:
BudgetOutlines:
Board of Directors:
Organization Logo
Signed: Jasmine Almeida
SAMPLE BUDGETS
BUDGET EXAMPLE 1
BUDGET EXAMPLE 2
** BE SURE TO INCLUDE ANY PLEDGED FUNDS