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American Cancer Society Pups Assisting With Support (PAWS) Facility Dog Grant Program Application

Thank you for your interest in the American Cancer Society Pups Assisting With Support (PAWS) Facility Dog Grant Program! Please submit the application via REDCap by May 31, 2024 at 11:59 pm ET.

Please read the RFA located at this link before beginning your application:

ACS PAWS RFA 2024-2025_FINAL.pdf

Please note that for the purposes of this application, "children" refers to individuals who are 0-19 years of age at the time of service, unless indicated otherwise.

You may direct questions in writing to acspaws@cancer.org.

Applicant Legal Name

* must provide value

Applicant Address

* must provide value

Applicant City

* must provide value

Applicant State/Territory

* must provide value

Applicant Zip Code

* must provide value

Applicant Tax ID Number

Applicant DUNS Number (Data Universal Numbering System)

What is the total patient population served between January 1, 2023 through December 31, 2023?

* must provide value

What is the total population of children served between January 1, 2023 through December 31, 2023?

* must provide value

What is the total population of children with cancer served between January 1, 2023 through December 31, 2023?

* must provide value

Are you able to provide an estimated percentage for the population of children with cancer by ethnicity and/or race?

* must provide value

Yes, can provide an estimated percentage for children with cancer by ethnicity and/or race

No, cannot provide an estimated percentage for children with cancer by ethnicity and/or race

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Please estimate the percentage of children with cancer served from January 1, 2023 through December 31, 2023 by ethnicity. Note: the row "Total" will be auto-calculated.

Ethnicity	Children (0-19 years of age)
Hispanic or Latino
Not Hispanic or Latino
Unknown
Prefer not to answer
Total

Please estimate the percentage of children with cancer served from January 1, 2023 through December 31, 2023 by race. Note: the row "Total" will be auto-calculated.

Race	Children (0-19 years of age)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Other
White
Two or more races
Unknown
Prefer not to answer
Total

Are you able to provide an estimated percentage for the population of children with cancer by insurance type?

* must provide value

Yes, can provide an estimated percentage of children with cancer by insurance type

No, cannot provide an estimated percentage for children with cancer by insurance type

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Please estimate the percentage of children with cancer served from January 1, 2023 through December 31, 2023 by health insurance type. Note: the row "Total" will be auto-calculated.

Health Insurance Type	Children (0-19 years of age)
Medicaid
CHIP
Medicare
Medicare + Medicaid
Medicare + Other
Medicare + Private
Military Program
Private
Uninsured
Prefer not to answer
Total

Are you able to provide an estimated percentage of children with cancer by age at the time of service?

* must provide value

Yes, can provide an estimated percentage for children with cancer by age at the time of service

No, cannot provide an estimated percentage for children by age at the time of service

reset

Please estimate the percentage of children with cancer served from January 1, 2023 through December 31, 2023 by age at the time of service. Note: the row "Total" will be auto-calculated.

Age	Children (0-19 years of age)
Newborn/infants (birth to 1 year)
Children (1 through 12 years)
Adolescents (13 through 19 years)
Total

Indicate your grant goal

* must provide value

Launch a new facility dog program

Support existing facility dog program

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Describe the need and rationale for implementing a facility dog program to serve patients and families in your hospital.

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Outline the proposed structure and goals of your facility dog program. Include details about training for dog and staff, handler responsibilities, and program logistics.

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Describe how your facility dog program will serve pediatric oncology patients and families and align with the mission of ACS PAWS.

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Outline the anticipated activities and interventions your facility dog and handler engage in with pediatric oncology patients and families.

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What is the name of the service dog organization that will be providing the facility dog?

When do you expect placement of a facility dog at your institution?

Describe how your hospital plans to evaluate the effectiveness and impact of the facility dog program once implemented. Include which metrics will be collected.

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How many facility dogs does your institution currently have?

How many of your institution's facility dogs provide visits to children with cancer?

Tell us more about the facility dogs that are providing visits to children with cancer, including their names, how long they've been a part of your program, which service dog organization they came from, and who their handler is.

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Describe your institution's facility dog program structure. Include details about training for dog and staff, handler responsibilities, and program logistics

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Describe how your facility dog program serves pediatric oncology patients and families and aligns with the mission of ACS PAWS.

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Outline the specific activities and interventions your facility dog and handler engage in with pediatric oncology patients and families.

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Describe how you currently measure the impact and success of your facility dog program. Include which metrics are collected.

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Estimated/expected number of total visits to children with cancer by the facility dog(s) during the grant period (Sept 2024 - Aug 2025)

* must provide value

Estimated/expected number of children with cancer visited by the facility dog(s) during the grant period (Sept 2024 - Aug 2025)

* must provide value

Please indicate if your organization will be able to provide the following information, which will be required as part of interim and final reports.

Yes

Number of facility dog visits to children with cancer

* must provide value

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Duration of visits by facility dog to children with cancer

* must provide value

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Number of children and caregivers served

* must provide value

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Children and caregiver general satisfaction

* must provide value

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In addition to the metrics listed above, we would also like to provide the opportunity for participating sites to submit meaningful stories and photos to demonstrate the impact that facility dogs have had for patients, caregivers, and staff. Some stories and photos will be shared through our work via briefs, reports, or presentations. Others may be shared back with our funders or through ACS promotions. Impact stories and photos will be requested as part of the interim and final reports, and participants will also be requested to submit a signed image and story release form upon sharing stories and photos.

Will you be able to provide the following information during the project?

Yes

Impact stories

* must provide value

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Photos

* must provide value

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Please provide any comments or context related to the collection of the above data criteria, impact stories, and photos.

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Describe how you plan to utilize the ACS PAWS grant funds to establish your facility dog program (e.g., procurement of dog, training, supplies, facilities improvement)

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Outline how the ACS PAWS grant funds will be utilized to support and enhance your existing facility dog program.

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Please upload your completed budget.

* must provide value

Upload file

Primary contact name

* must provide value

Primary contact title

Primary contact email address

* must provide value

Primary contact phone number

Secondary contact name

Secondary contact title

Secondary contact email address

Secondary contact phone number

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