HOPES
Infant Safe Sleep Hospital Model of Excellence Award Program -
Spring 2015

Application Instructions

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.

*If you HAVE applied and were recognized as a leader in 1-3 areas of excellence in the last 2 years.

You DO NOT need to reapply in the areas in which you have been recognized as a Leader in the last 2 years. You DO 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 with any questions. You must also submit a new application and executive commitment form.

*If your hospital is currently an Infant Safe Sleep Hospital Model of Excellence

You must reapply using the renewal application, below. You must clearly state how your hospital has implemented your infant safe sleep policies and practices over the past two years and how your hospital will continue to implement them in the next two years.

HOW TO APPLY

Click on the links below to download the application forms. Read through the award criteria first and then begin filling out your application. We suggest filling out as much as possible online and save to your computer. You can then print and add any signatures indicated.

The executive commitment form must be signed by a hospital executive, ex. hospital president or CEO, Chief of Staff or Chief Nurse.

NEW APPLICATION

Award Criteria

1. Application
2. Executive Commitment Form
3. Policy
4. Staff Training/Education
5. Parent Education/Modeling
6. Community Outreach

RENEWAL APPLICATION

Award Criteria

1. Application
2. Executive Commitment Form
3. Policy
4. Staff Training/Education
5. Parent Education/Modeling
6. Community Outreach

Attachments
All attachments MUST be labeled with one of the following headers as it corresponds to each area AND the name of your hospital:

• Policy
• Staff Training
• Parent Education
• Community Outreach

Type or hand-write this information. Pages not labeled correctly may be disregarded.

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SUBMITTING YOUR APPLICATION

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

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

2. Email
Send all electronically completed forms and attachments to: information@NCHealthyStart.org

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.

All documents must be received by 5 PM April 15, 2015. Applications received after this date may not be reviewed until the next cycle.

NEXT STEPS

You will be notified within one month the results of your self-nomination. If your hospital is recognized as a Model of Excellence, new or renewal, you will receive:

1. An award letter
2. A press release template
3. A plaque (that will arrive 2-4 weeks later)

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 2-4 weeks later)

NCHSF will post the names of the awardees on the home page of our website, and in our newsletter Happenings, we will announce the hospital names on our social media outlets and we will provide a list of awardees to the NC Hospital Association and Child Fatality Task Force.

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