Equity and Innovation Grants

Primary Project Lead First Name *

Primary Project Lead Last Name *

Primary Project Lead Email Address *

Secondary Project Lead First Name *

Secondary Project Lead Last Name *

Secondary Project Lead Email Address *

DPH Sponsor First Name *

DPH Sponsor Last Name *

DPH Sponsor Email *

Please also confirm the name of the ZSFG Executive Sponsor and UCSF Chief from whom you have obtained approval for your project scope and budget line items.

Project approvals are required from your DPH Sponsor, a ZSFG Executive*, and a UCSF Service Chief**

You can refer to the table below listing respective personnel for each role. Applicants must provide a draft proposal to the designated ZSFG Executive and UCSF Service Chief by June 16.

*ZSFG Executive approval reference list:

NAME	TITLE
Angelica Almeida	Chief Integrative Officer
Jeffrey Critchfield	Interim Vice Dean
Susan Ehrlich	Chief Executive Officer
Christine Falvey	Chief Communications Officer
Angelica Journagin	Chief Administrative Officer
Hemal Kanzaria	Chief of Performance Excellence
Mary Mercer	Chief of Staff
Gabriel Ortiz	Chief Medical Officer
Gillian Otway	Chief Nursing Officer
Sabrina Robinson	Chief Operating Officer
Adrian Smith	Chief Quality Officer
Eric Wu	Chief Financial Officer

** A UCSF Chief is not required to approve the proposal if it is focused exclusively on DPH-operated services. In that case, please indicate "N/A" in required fields.

ZSFG Executive Sponsor First Name *

ZSFG Executive Sponsor Last Name *

ZSFG Executive Sponsor Email *

UCSF Chief First Name *

UCSF Chief Last Name *

UCSF Chief Email Address *

Please upload your Proposal Notification Form (PNF) here. *

The PNF should be completed by your DPH Sponsor and uploaded in Word format. Note that only the yellow highlighted fields need to be completed.

Proposal Notification Form

Project Title *

1) Project Summary (Executive Summary): Please provide a general description of the proposed project in 1-3 sentences. *

(maximum 1000 characters with spaces)

2) Describe the proposed project and the overall impact your project attempts to make. Please outline any partnerships or collaborations, and how this project will play an impactful role in the hospital / the community. This can include narrative from the Grant Application Summary (#17) in the PNF.* *

(maximum 3000 characters with spaces)

3) Describe the issue the project is attempting to address. Provide concrete details of the specific challenges or obstacles, and cite data if possible. *

(maximum 3000 characters with spaces)

4) How does this project align with the ZSFG True North Goals? *

(maximum 1500 characters with spaces) ZSFG True North Goals

5) Outline the project implementation plan for the intended 2-year funding timeframe. State at least three measurable objectives and the activities that will help to achieve each objective, with a timetable for completion of each objective. Include the number of patients treated and/or number of staff trained as one of the objectives. *

(maximum 3000 characters with spaces)

6) Is there potential for the project to be scaled up or replicated to beneﬁt a broader population or additional healthcare settings? If so, please explain. *

(maximum 1500 characters with spaces)

7) What are the anticipated short- and long-term outcomes of the project, particularly in terms of improving health outcomes, reducing disparities, and advancing health equity? *

(maximum 1500 characters with spaces)

8) Optional: Please include or upload any supplemental materials (e.g. videos, deck presentations, flyers, articles, etc.) that have already been created and can contribute to describing your proposed project.

Please use the Budget Form and provide as much detail within your budget as possible. *

If multiple items fall within one category (e.g. materials and supplies), please add additional rows for further breakdown of the details within line items. You may need to include multiple rows for example general supplies, medical supplies, other supplies, etc. Include in your basis of cost estimates additional details, such as what supplies include, cost and number of items to be purchased. Your selected categories might change to better align with the hospital’s budget accounts.

For any UC personnel who will be included in the requested budget, they must already be approved through the Affiliation Agreement in order to be reimbursed.

Please upload the Budget Form in Excel format.

Budget Form

Equity and Innovation Grants 2025 Application

Equity and Innovation Grants 2025 Application

Equity and Innovation Grants 2025 Application