CREATE Application

Below is the CREATE Application. If you’re seeing this page, you should have already completed the pre-application steps and received an application number.
If you have not, please contact us by email at web@coruralhealth.org . You must have an application number in order for your application to be considered for funding.

For examples of required attachments, click below:

Balance Sheet Example

Budget Example

Income Statement Example

Full Application for CREATE - gated

Step 1 of 6

Course #2 (IF APPLICABLE) - EMTS Training & Education Request Details
Please only fill out this section if you are applying for more than one course.
Course #2 Name
Course #2 Start Date
MM slash DD slash YYYY
Course #2 End Date
MM slash DD slash YYYY

The course end-date represents the date that all course requirements have been completed (passed class, completed internships/clinicals, etc.). Approved applications for training that requires National Registry examination are provided a 3-month window after the noted course end-date to take and pass the NR exam.
Class Location for Course #2
Student Quantity Requested for Course #2
Trainer
Training Center
What kind of course is this (course 2)?
- College Credit
- Non-College Credit
Course #2 Tuition/Course Cost
Other Cost (books, fees, etc.)
Other Cost - description
Other Costs (books, fees, etc.)
Backup for all course costs associated with course #2
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 6.
Travel Cost - Mileage (Max. = State of Colorado rate)
Include travel to course/training and other travel considerations such as clinicals, internship, etc. It's recommended that applicant demonstrate cost-saving measures that ensure the most cost-effective option has been considered (such as carpooling).
Travel Cost - Lodging
Estimated total lodging cost should be calculated for all nights requested (room rate * # of nights + applicable fees/tax) It's recommended that applicant demonstrate cost-saving measures that ensure the most cost-effective option has been considered. This includes using shared rooms, condo rentals for large groups, etc. If utilizing shared lodging, divide the estimated total cost by the # of people.
Mileage/Lodging Request Details
You MUST note the estimated number of trips, destination of trips, and the estimated total roundtrip mileage of those trips. For example, 6 month course, 3 days a week, X estimated number of total trips to course, roundtrip mileage for 1 trip, calculated total roundtrip mileage = (total trips) * (roundtrip mileage for 1 trip) = total roundtrip mileage to course. Do the same for other required travel such as clinicals, internship, etc. Comments could also include information related to cost-saving efforts like carpooling or shared lodging. If not using cost-saving efforts, use comment box to describe why.
Backup for mileage and lodging requests
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 6.
Total Cost Per Student
Total Cost of course for all students
Comments
COURSE #2 (IF APPLICABLE) - Service Need Narrative (40 pts Possible)
Explain the need for educational courses to upgrade or maintain current levels of services. Note - Do not include demographic information related to race/ethnicity of a population or region or the age of current providers at applicant agency(s).
Educational Purpose: Describe how the requested education or training will benefit your entity and the community you serve, and how it targets the EMS and trauma system. Provide supporting data. (15 points)
Service Enhancement: Describe your current level of service and how the requested education or training will upgrade or maintain the level of service. Identify who is eligible to participate in the training or education. (10 points)
System Deficiency or Unmet Need: Explain how the requested education or training addresses a system deficiency or unmet service need in the community you serve. (10 points)
Local Support: Describe how the requested education or training will enhance collaborative efforts with local partners and stakeholders, and how their support will ensure successful completion. Provide letter(s) of support from partners or stakeholders. (5 points)
Letters of Support (optional)
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 6.
COURSE #2 (IF APPLICABLE) - Cost Effectiveness of Project Budget (15 pts possible)
Describe how measures were taken to ensure that the most cost effective choices were made. Note - Do not include demographic information related to race/ethnicity of a population or region or the age of current providers at applicant agency(s).
Describe alternatives to the requested training that your entity considered, provide a cost comparison of those alternatives, and explain why the requested education or training is the best option. (10 points)
List all costs of the requested education or training and explain why they are necessary to complete the education or training. (5 points)
Download a PDF of Your Application (click the arrow in the upper right of the PDF preview)

Save and Continue Later (you MUST copy your link and store it somewhere safe)

Course #3 (IF APPLICABLE) - EMTS Training & Education Request Details
Please only fill out this section if you are applying for more than 2 courses.
Course #3 Name
Course #3 Start Date
MM slash DD slash YYYY
Course #3 End Date
MM slash DD slash YYYY

The course end-date represents the date that all course requirements have been completed (passed class, completed internships/clinicals, etc.). Approved applications for training that requires National Registry examination are provided a 3-month window after the noted course end-date to take and pass the NR exam.
Class Location of Course #3
Student Quantity Requested for Course #3
Trainer
Training Center
What kind of course is this (course 3)?
- College Credit
- Non-College Credit
Course #3 - Tuition/Course Cost
Other Cost (books, fees, etc.)
Other cost description
Other Cost (books, fees, etc.)
Other Cost - description
Backup for Course #3 - Course/Tuition Cost + Other Costs
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 6.
Travel Cost - Mileage (Max. = State of Colorado rate)
Include travel to course/training and other travel considerations such as clinicals, internship, etc. It's recommended that applicant demonstrate cost-saving measures that ensure the most cost-effective option has been considered (such as carpooling).
Travel Cost - Lodging
Estimated total lodging cost should be calculated for all nights requested (room rate * # of nights + applicable fees/tax) It's recommended that applicant demonstrate cost-saving measures that ensure the most cost-effective option has been considered. This includes using shared rooms, condo rentals for large groups, etc. If utilizing shared lodging, divide the estimated total cost by the # of people.
Mileage/Lodging Details
You MUST note the estimated number of trips, destination of trips, and the estimated total roundtrip mileage of those trips. For example, 6 month course, 3 days a week, X estimated number of total trips to course, roundtrip mileage for 1 trip, calculated total roundtrip mileage = (total trips) * (roundtrip mileage for 1 trip) = total roundtrip mileage to course. Do the same for other required travel such as clinicals, internship, etc. Comments could also include information related to cost-saving efforts like carpooling or shared lodging. If not using cost-saving efforts, use comment box to describe why.
Backup for mileage/lodging requests
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 6.
Total Cost per Student
Total cost of course for all students
Comments
COURSE #3 (IF APPLICABLE) - Service Need Narrative (40 pts Possible)
Explain the need for educational courses to upgrade or maintain current levels of services. Note - Do not include demographic information related to race/ethnicity of a population or region or the age of current providers at applicant agency(s).
Educational Purpose: Describe how the requested education or training will benefit your entity and the community you serve, and how it targets the EMS and trauma system. Provide supporting data. (15 points)
Service Enhancement: Describe your current level of service and how the requested education or training will upgrade or maintain the level of service. Identify who is eligible to participate in the training or education. (10 points)
System Deficiency or Unmet Need: Explain how the requested education or training addresses a system deficiency or unmet service need in the community you serve. (10 points)
Local Support: Describe how the requested education or training will enhance collaborative efforts with local partners and stakeholders, and how their support will ensure successful completion. Provide letter(s) of support from partners or stakeholders. (5 points)
Letters of Support (optional)
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 6.
COURSE #3 (IF APPLICABLE) - Cost Effectiveness of Project Budget (15 pts possible)
Describe how measures were taken to ensure that the most cost effective choices were made. Note - Do not include demographic information related to race/ethnicity of a population or region or the age of current providers at applicant agency(s).
Describe alternatives to the requested training that your entity considered, provide a cost comparison of those alternatives, and explain why the requested education or training is the best option. (10 points)
List all costs of the requested education or training and explain why they are necessary to complete the education or training. (5 points)
Download a PDF of Your Application (click the arrow in the upper right of the PDF preview)

Save and Continue Later (you MUST copy your link and store it somewhere safe)

Priority to Underdeveloped or Aged Systems Narrative (10 pts possible)
Describe the need to update an underdeveloped or aged system. Note - Do not include demographic information related to race/ethnicity of a population or region or the age of current providers at applicant agency(s).
Explain how the requested education or training addresses an underdeveloped or aged component(s) of the EMS and trauma system in your community.*
Applicant's Qualifications (10 points possible)
Describe how your organization will provide the necessary resources and experience to successfully implement the project, as well as what qualifications your organization has to help ensure long term sustainability. Note - Do not include demographic information related to race/ethnicity of a population or region or the age of current providers at applicant agency(s).
Adequate Resources and Experience: Explain how your entity has the administrative capability and financial resources available to manage a reimbursement grant of the duration and dollar amount requested. (5 points)*
Long Term Sustainability: Explain how your entity intends to support the continued competency of providers trained through this request and maintain level of services in the future without relying on grant funding. (5 points)*
Credentials or documentation upload
Accepted file types: pdf, Max. file size: 50 MB.
*All attached documents must be in PDF Format
If applicable, please explain the Course Coordinator's role in pulling this course together to help ensure a successful event and explain any other related, pertinent experience this Course Coordinator has.
Systems Integration (10 Pts Possible)
Note - Do not include demographic information related to race/ethnicity of a population or region or the age of current providers at applicant agency(s).
System Integration: Describe how the proposed education or training integrates with other services in the community and improves continuity of patient care. (5 points)*
Duplication: Describe how the requested education or training is not a duplication of other efforts in your area. (5 points)*
Financial Need Narrative (15 Pts Possible)
FOR MULTI-AGENCY APPLICATIONS: For all participating agencies, please include relevant financial information within narratives and attach relevant financial statements for those agencies. Note - Do not include demographic information related to race/ethnicity of a population or region or the age of current providers at applicant agency(s).
Financial Need: Explain why the requested training or education requires grant funding assistance. Provide clear reference(s) to line item(s) within the required financial statements. Explain any surplus/deficit/cash balances/cash reserves. (5 points)*
For multi-agency applications, you must explain the financial need of participating agencies, provide their financial documents, and include letters of support from all participating agencies.
Attach any additional financial statements or other relevant attachments
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 10.
If your EMTS entity is part of a larger organization, provide the required financial statements for the larger organization and supplemental financial statements specific to the EMTS operation. If submitting a multi-agency application, attach applicable financial statements of other partner agencies involved in grant.
Entity Financial Outlook: Describe your entity’s current financial status. Provide clear references to the required financial statements. (5 points)*
Cash Match: Clearly describe source of the required cash match. (5 points)*
Download a PDF of Your Application (click the arrow in the upper right of the PDF preview)

Save and Continue Later (you MUST copy your link and store it somewhere safe)

Attachments
Three required financial documents must be attached to your application. Applications submitted without these documents will not receive a review. *All attached documents must be in PDF Format. Do not include entire annual report. Unaudited statements are acceptable. Copies of statements submitted to Division of Local Government or CDPHE are also acceptable.
Balance Sheet at the end of the most recently completed fiscal year (for the period from January 1- December 31 for entities on a calendar year accounting cycle).*
Accepted file types: pdf, Max. file size: 50 MB.
*All attached documents must be in PDF Format. Do not include entire annual report. Unaudited statements are acceptable. Copies of statements submitted to Division of Local Government or CDPHE are also acceptable.
Income Statement at the end of the most recently completed fiscal year (for the period from January 1- December 31 for entities on a calendar year accounting cycle).*
Accepted file types: pdf, Max. file size: 50 MB.
*All attached documents must be in PDF Format. Do not include entire annual report. Unaudited statements are acceptable. Copies of statements submitted to Division of Local Government or CDPHE are also acceptable.
Budget for current fiscal year (for the period from January 1- December 31 for entities on a calendar year accounting cycle).*
Accepted file types: pdf, Max. file size: 50 MB.
*All attached documents must be in PDF Format. Do not include entire annual report. Unaudited statements are acceptable. Copies of statements submitted to Division of Local Government or CDPHE are also acceptable.
Additional Attachments
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 6.
*All attached documents must be in PDF Format. If you choose to include other attachments that would be useful to reviewers, they must be combined into one PDF file and submitted electronically with your electronic application. If you do not have the capability to combine your attachments, please contact the CREATE Grants Manager for assistance and suggestions. (Examples of attachments may include, but are not limited to, estimates of mileage (maps showing distances), estimates of lodging, quotes from potential instructors, letters of support, etc.)
Download a PDF of Your Application (click the arrow in the upper right of the PDF preview)

Save and Continue Later (you MUST copy your link and store it somewhere safe)

CREATE Application

Step 1 of 6

General Project Details

Match and Request Amount Calculations

Course Info

Course #1 - EMTS Training and Education Request Details

Other Course Costs for Course #1

Course #1 - Mileage and Lodging Information

Course #1 - Service Need Narrative (40 pts Possible)

Course #1 - Cost Effectiveness of Project Budget (15 pts possible)

Course #2 (IF APPLICABLE) - EMTS Training & Education Request Details

COURSE #2 (IF APPLICABLE) - Service Need Narrative (40 pts Possible)

COURSE #2 (IF APPLICABLE) - Cost Effectiveness of Project Budget (15 pts possible)

Course #3 (IF APPLICABLE) - EMTS Training & Education Request Details

COURSE #3 (IF APPLICABLE) - Service Need Narrative (40 pts Possible)

COURSE #3 (IF APPLICABLE) - Cost Effectiveness of Project Budget (15 pts possible)

Priority to Underdeveloped or Aged Systems Narrative (10 pts possible)

Applicant's Qualifications (10 points possible)

Systems Integration (10 Pts Possible)

Financial Need Narrative (15 Pts Possible)

Attachments

Authorized Agent Attestation

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