RPSA Potential Partnership Application Survey

This survey is for informational purposes only, so that potential primary applicant organizations and subrecipients can participate in a partnership application model. Survey responses, including contact information, will be made public on IDHS Firearm Violence Prevention. Please visit this site after completing this survey to find organizations that may match with you in your community.

The Illinois Department of Human Services (IDHS) is administering competitive funding notices to identify and fund organizations that will provide comprehensive evidence-based firearm violence prevention services in eligible Chicago community areas. IDHS, Office of Firearm Violence Prevention, will award grants to eligible community organizations and local governments to provide Violence Prevention Services program elements including street outreach, case management, and victim services.

IDHS strongly encourages application partnerships if any single organization is unable to provide all three violence prevention services as described in NOFO 23-444-80-2774. Organizations serving the same community area are encouraged to partner to provide each of the required services and apply for funding under one primary applicant organization. The primary applicant organization must provide at least one of the required Violence Prevention service components and may subgrant with one or more eligible organizations to provide the remaining service components. Sub-recipient entities will be subject to the same GATA and grant requirements as the primary applicant organization (grantee). Please visit IDHS GATA Prequalification Assistance to learn how to become pre-qualified.

Again, the purpose of this survey is to match potential primary applicants and subrecipients who may be interested in partnering on an application in their community. If interested in serving as a potential primary applicant or subrecipient, please complete the following section accordingly:

My organization is interested in serving as a potential (check all that apply):

• Prime Recipient
• Subrecipient

Organization:

Address:

City:

ZIP:

Primary Contact

Name:

Title:

Phone:

Email:

Is your organization GATA pre-qualified? Yes No

Does your organization provide violence prevention services? Yes No

Please select the violence prevention services your organization provides:

• Street Outreach
• Case Management
• Victim Services
• Group Violence Interventions
• Mental Health Services
• Other (Specify):

Please select which community(ies) your organization is currently serving:

• Ashburn
• Auburn Gresham
• Austin
• Burnside
• Chatham
• Chicago Lawn
• East Garfield Park
• Englewood
• Fuller Park
• Greater Grand Crossing
• Humboldt Park
• New City
• North Lawndale
• Northside Cluster (Belmont Cragin, Hermosa, Logan Square, Avondale, Irving Park, Albany Park, Riverdale)
• Roseland
• South Chicago
• South Deering
• South Lawndale
• South Shore
• Southwest Side Cluster (Lower West Side, Brighton Park, Gage Park, McKinley Park)
• Washington Park
• West Englewood
• West Garfield Park
• West Pullman
• Woodlawn

Please select the following RPSA Violence Prevention Services your organization is able to provide.

• Street Outreach - Street outreach workers mediate conflicts and prevent retaliatory violence between those who are at risk to commit or become the victims of firearm violence.
• Case Management - Uses a case manager or case team to complete an intake assessment, develop a case plan, and provide or connect individuals to identified resources and services.
• Victim Services - Victim services workers/advocates help families and victims of violence recover from physical and emotional trauma caused by the violence by empowering them with skills, services, and opportunities.