HOPES
Infant Safe Sleep Hospital Model of Excellence Award Program

Application Instructions
How to Apply
Submitting your Application
Next Steps

APPLICATION INSTRUCTIONS - January 2012

Read through all of the following instructions carefully. Answers should be brief but thorough.  

*If you have NOT previously applied

You may apply to be recognized in 1-4 areas of excellence. If you apply for less than 4 areas of excellence, you are eligible to be recognized as a Leader in each of those areas. If you apply for all four areas of excellence you are eligible for the Model of Excellence award.

Please review the award criteria to determine which areas of excellence you are qualified to apply for. After reading the criteria, if you still have questions, contact the North Carolina Healthy Start Foundation.

*If you HAVE applied before and were recognized as a leader in 1-3 areas of excellence

You DO NOT need to reapply in the areas in which you have already been recognized as a Leader. You will need to apply or reapply for the areas of excellence that you were not recognized as a leader. Refer to your award letter for this information. If you are unsure, please contact the North Carolina Healthy Start Foundation with any questions.

HOW TO APPLY

Click on the blue links to download the materials below, you will need adobe acrobat to view these files in the PDF format. Read through the award criteria first and then begin filling out your application.  Please fill out your application online and save to your computer. You can also fill out the area of excellence forms online as well as the executive commitment form by filling in the areas shaded in blue.  You can then print, and add a signature where indicated. 

1. Award Criteria
2. Application ( word document format)
3. Area of Excellence Forms (only fill out the forms for which areas you are applying)
   1. Policy ( word document format)
   2. Staff Training/Education ( word document format)
   3. Parent Education/Modeling ( word document format)
   4. Community Outreach ( word document format)
4. Attachments
   All pages MUST be correctly labeled with:
   1. The name of your hospital
   2. The number that corresponds with the attachment number listed on the Area of Excellence forms.

Add header to the top of each page. For example, if an attachment is 5 pages long, each of the five pages should have the same header. You may type or hand-write this information. Pages not labeled correctly may be disregarded.

This example corresponds with the first Policy attachment.

5. Executive Committee Form ( word document format) This document must be signed by a hospital executive, ex. hospital president or CEO, Chief of Staff of Chief Nurse.

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SUBMITTING YOUR APPLICATION

1. By mail
Send all completed forms and attachments to:

Jacquie Simmons
The North Carolina Healthy Start Foundation
3725 National Drive
Suite 105
Raleigh, NC 27612

2. Email
Send all electronically completed forms and attachments to:

3. By fax
Fax all completed forms and attachments to:
(919) 828-1446

You must include a fax cover page with the total number of pages clearly listed and put attn: Jacquie Simmons.

All documents must be receive by March 15th 2012. Applications received after this date may not be reviewed until the next cycle.

Assistance with applications is available through the Foundation. For questions, please contact Jacqueline Simmons 919 828 1819 or

NEXT STEPS

You will be notified by April 1, 2012 with the results of your self-nomination. If your hospital is recognized as a Model of Excellence, you will receive:

1. An award letter
2. A press release template
3. A plaque (that will arrive later in the month)

If your hospital is recognized as a Leader in 1, 2 or 3 areas of excellence, you will receive:

1. An award letter
2. A press release template
3. A certificate (that will arrive later in the month)

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