Next Step Health Careers Academy

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Executive Summary

Next Step Health Careers Academy is a nonprofit in Massachusetts that trains adults for in-demand entry-level jobs in health care and helps them climb the career ladder from there. Our free, short, hands-on programs prepare people to become certified nursing assistants and phlebotomy technicians in Year 1, with a medical assistant program beginning in Year 3. Each program is taught by experienced nurses and clinicians, includes supervised practice at real health care sites and leads to the state or national certification employers require. A stipend, childcare and transportation help, scrubs and exam fees, and a Career Coach who stays with each graduate for a year remove the barriers that keep many people from finishing.

Hospitals, nursing homes and home care agencies across our region are struggling to fill direct care and clinical support jobs, and the shortage touches every family when a loved one needs care. At the same time, many adults in our community are out of work or stuck in low-wage jobs that do not lead anywhere, and many have the compassion and reliability that great caregivers need. What they lack is a fast, affordable route into the field. Commercial training can cost thousands of dollars, college programs can take a year or more, and almost none help with childcare, rides or the first job.

With this grant we will enroll about 72 adults in Year 1: three nursing assistant cohorts and three phlebotomy cohorts of about 12 each. We expect about 61 graduates. Our goal is that at least 85% of those who sit for a certification exam pass it and that about 46 graduates are working in health care within 90 days. We also advise every graduate on the next rung of the ladder, such as practical or registered nurse programs through our community college partner and employer tuition help. We do not promise any participant a job or a wage, and some criminal records can bar a person from certain patient care jobs under state law, so we advise every applicant honestly before they enroll.

Our Year 1 budget is about $523,500, growing to about $897,000 by Year 5 as we add instructors, a medical assistant track and a career coach and serve about 176 adults a year. Each year's budget is planned to balance, with a small surplus each year. We have 6 paid staff in Year 1 and 10 by Year 5. Seats sponsored by health employers, the workforce board and state funds grow from about 21% of our income in Year 1 to about 35% in Year 5, so grants fall from about 75% to about 58%.

We are asking the Bay State Health Workforce Fund for $100,000 for one Nurse Instructor, participant stipends, childcare and transportation support, and scrubs, exam and screening fees. Sponsored seats, other grants and donors cover the rest, so this grant is one part of a shared funding plan.

I am Patricia Nwosu, a registered nurse and the Executive Director. The numbers in this proposal are estimates based on the assumptions listed at the end, not promises.

Company Description

Next Step Health Careers Academy is a nonprofit organization in Massachusetts. We are a 501(c)(3) public charity (or a program of one, through a fiscal sponsor), governed by a volunteer board of directors. We will provide our IRS determination letter, board list and most recent financial statements with this proposal.

Our mission. To open pathways into health care careers for people who want to care for others and to help them build lasting careers.

What we believe. Caring for others is skilled, important work, and the people who do it deserve training, respect and fair pay. People who come from the communities served by health care bring understanding that no textbook can teach. A first health care job should be a first step, not a dead end, so every graduate should leave with a plan for the next step. Training should be built with the employers who hire, taught by people who have done the work and designed to fit the lives of working adults and parents.

How we started. Next Step began when the director of nursing at a long-term care facility, a hospital nurse educator and a community college adult education instructor noticed that their facilities had dozens of open nursing assistant positions while local adults who wanted the work could not afford training or pass the exam. They set up an evening class in a church hall with borrowed supplies and a volunteer nurse instructor. In two years, 46 people took the class, 39 completed it, 34 passed the state exam and 29 were hired by local employers. Employers began asking for more graduates, and the county workforce board asked whether we could offer training regularly. This proposal asks for support to turn that class into a staffed, state-approved academy.

What we offer:
- Certified nursing assistant (CNA) training. A state-approved nurse aide program of classroom, skills lab and supervised clinical practice that prepares students for the state competency exam and for work in nursing homes, hospitals, home care and assisted living. The program meets or exceeds the federal minimum hours and any higher state requirement, including supervised practice with residents or patients.
- Phlebotomy technician training. About 8 to 10 weeks of classroom and lab learning and supervised practice in collecting blood samples safely, with preparation for a national certification exam.
- Medical assistant training (beginning Year 3). About 16 to 20 weeks of training in clinical and administrative skills for clinics and medical offices, with preparation for a national certification exam.
- Foundational skills. Help with math, reading, medical terminology and digital skills, and referral to adult education for people who need a high school equivalency.
- Supports. A training stipend, scrubs and supplies, help with exam, background check and health screening fees, childcare help and transportation help.
- Career coaching and placement. Resume help, interview practice, introductions to employers, follow-up for 12 months after hire and advice on the next step, such as licensed practical nurse or registered nurse programs, with employer tuition assistance where it exists.
- Employer partnership. Hospitals, nursing homes and home care agencies help design the training, provide clinical sites, interview graduates and may sponsor seats.

What we do not do. We do not promise any participant a job or a wage. We do not charge participants for any part of the program. We do not guarantee that a participant will pass a certification exam or be certified, since certification depends on the state and the exam. We do not provide medical care, and participants do not provide independent patient care during training.

How we are run. A seven-member volunteer board of directors oversees the organization and approves the budget each year. The board includes a director of nursing at a long-term care facility, a hospital nurse educator, a community college nursing dean, a home care agency director, a certified nursing assistant who now works as a nurse, a pastor and a certified public accountant. The Executive Director, who is a registered nurse, manages the organization and employer partnerships, the Program Director leads the training, and an outside accountant reviews our books every year.

Where things stand today. Seven employers have signed letters offering clinical sites, interviews and sponsored seats, and the local workforce board has invited us to apply to be an approved training provider. We have applied to the state agency for approval of our nurse aide training program, and we have a letter of intent for a 6,500 square foot space with a classroom and a skills lab. Before we begin, an attorney will review our lease, our clinical site and employer agreements, and our participant and privacy policies.

Problem & Opportunity

Why this program is needed.

The demand for health care workers is growing as the population ages and more people need care. Nursing homes, hospitals, home health agencies and clinics across Massachusetts report high vacancy and turnover rates for direct care and clinical support jobs. When these positions go unfilled, residents and patients wait for care, and the staff who remain are stretched thin. Many of these jobs are an entry point to better-paying careers, and employers often offer tuition help to workers who want to advance to nursing and other licensed roles.

The gaps we see:
1. Cost and time. Private training for nursing assistants or phlebotomy can cost hundreds to thousands of dollars. Many adults cannot afford to pay and cannot stop working to attend a long program.
2. Hard-to-reach training. Many programs are offered only during the day, far from the neighborhoods where people live, or with long waiting lists.
3. Costs beyond tuition. Scrubs, shoes, background checks, health screenings, exam fees, childcare and bus fare can add up, and they often stop people who have paid the tuition.
4. Barriers to certification and hiring. Many applicants do not know that some criminal records can bar them from nurse aide certification or from patient care jobs under state law, and they may spend time and money before learning this. Others are not sure which immunizations or screenings they need.
5. Exam anxiety and language. Many capable people struggle with the written exam, medical terms or English as a second language, and there are few supports.
6. Stuck on the bottom rung. Many direct care workers earn low wages and do not know how to move up. Employers may offer tuition help, but workers lack guidance on how to use it.
7. Early turnover. Many new health care workers leave in the first year because of burnout, schedules, a lack of mentoring or transportation, and few programs provide follow-up.
8. Unequal opportunity. Direct care roles are filled disproportionately by women, immigrants and people of color, who are often underpaid and underrepresented in higher-paying, licensed roles. Programs need to open ladders, not just entry points.

What the evidence says. Training programs built with employers, with hands-on practice, supports for participants and coaching after hire, tend to produce better employment results than programs without them. Results vary by program and local market, and we will measure and report our own.

How we know people want this. In our pilot, 46 people enrolled, 39 completed, 34 passed the state exam and 29 were hired. Seven employers told us they would hire or interview more graduates if we offered training regularly. The workforce board has a waiting list of eligible adults interested in health care.

How we will show the need. Before we submit this proposal, we will add the number of job openings and the vacancy and turnover rates for nursing assistants, phlebotomists and medical assistants in our region from the Massachusetts Executive Office of Labor and Workforce Development, the U.S. Bureau of Labor Statistics and employer letters, the typical wages for those jobs from the Bureau of Labor Statistics and local postings, the unemployment rate in our target neighborhoods from the Census Bureau and the number of adults on the workforce board's waiting list.

Who benefits first. Adults 18 and older in our service area who want to work in health care, especially people who are unemployed or underemployed, parents returning to work, immigrants and people with limited English, veterans and people who want a first step toward a nursing or clinical career. Also the residents and patients who need care, and the employers who need staff.

Products & Services

What the grant will pay for and what we will do.

1. Recruit and screen honestly. We recruit through the workforce board's career centers, churches, libraries, adult education programs, health care employers and word of mouth. Applicants attend an information session, an interview and a short assessment. Before enrollment, we explain the state's requirements for certification, including background checks and health screenings, and we advise any applicant whose record may affect certification so that no one invests time in a pathway they may not be able to complete. We help applicants understand their options and refer them to other careers if a health care role is not open to them. About 12 adults join each cohort, with six cohorts in Year 1.

2. Teach a state-approved nursing assistant program. Our CNA program follows the state's approved curriculum and includes classroom learning, hands-on practice in our skills lab and supervised clinical practice at a long-term care facility or hospital. Topics include basic nursing skills, safety, infection control, residents' rights, communication, mobility and positioning, personal care, nutrition, dementia care, end-of-life care and the nursing assistant's role in the health care team. Instructors are registered nurses who meet the state and federal requirements for nurse aide training instructors, which we confirm with the state. Students prepare for the state competency exam, including the skills test, and receive practice testing.

3. Teach phlebotomy. Students learn anatomy, safe blood collection, infection control, specimen handling, patient identification and communication. Students practice on training arms in our lab, and in supervised settings at clinical sites, in line with state rules. They prepare for a national certification exam, such as those offered by recognized certifying bodies. Instructors are certified phlebotomy technicians and nurses with clinical experience.

4. Add a medical assistant program in Year 3. A longer program of clinical and administrative skills for clinics and medical offices, with supervised practice and exam preparation.

5. Teach the habits that matter. Every program includes patient privacy and HIPAA, bloodborne pathogens and infection control training, safe patient handling and body mechanics, professional communication, cultural humility, boundaries, stress management and how to speak up about safety.

6. Remove barriers. Each participant receives a training stipend of $600 over the program, tied to attendance, plus scrubs and supplies, help paying for the exam, background check and health screening, childcare help, and bus passes or gas cards. We pay for these directly to providers or vendors whenever possible. Participants who receive unemployment benefits are helped to check with the state agency about how training and stipends affect their benefits.

7. Coach every participant to a job and a next step. The Career Coach and Employer Liaison helps with resumes, interviews and mock interviews with employers, introduces graduates to hiring managers and follows up on applications. The coach also helps each graduate map the next rung, such as licensed practical nurse or registered nurse programs at our community college partner, and how to use employer tuition assistance. We do not promise a job.

8. Support the first year. The Career Coach checks in at 30, 90, 180 and 365 days after hire, helps with problems such as schedules, rides or conflicts, and connects graduates to mentors and peers.

9. Partner with employers. Employers help review the curriculum, provide clinical sites and guest instructors, interview graduates and may sponsor seats. About 8 employers take part in Year 1.

How we will measure results. We track enrollment, attendance, completion, exam attempts and pass rates, employment in health care at 90 days, 6 months and 12 months, wages and hours, retention and advancement to a next credential or role. We ask every participant, clinical site and employer for feedback. We report results by gender, race and background so that we can find and fix gaps.

Our Year 1 goals:
- About 72 adults enroll in six cohorts, with at least 85% completing the program, about 61 graduates.
- At least 85% of graduates who sit for a certification exam pass it.
- At least 75% of graduates are working in health care within 90 days, about 46.
- At least 75% of graduates who are hired are still employed at 6 months.
- At least 90% of participants say they would recommend the program.
- At least 90% of clinical sites and employers say they would work with us again.
- About 8 employers take part, with at least 5 interviewing or hiring graduates.
These are goals, and we will report our real results to the Fund, including where we fall short. We do not promise a job or a wage to any participant.

Market Analysis

Who we serve and how many.

The people. Adults 18 and older who live in our service area and want to work in health care. We welcome everyone, whether or not they have health care experience, a diploma or a clean record, and we reach out especially to people who are unemployed or underemployed, parents returning to work, immigrants and people with limited English, veterans, people who want a first step toward a nursing career and residents of neighborhoods with high unemployment. Participants must be authorized to work in the United States and must be able to meet the state's certification requirements, which we explain before enrollment.

Where we work. Our skills lab and classroom are in a leased space near a bus line, with supervised clinical practice at nursing homes and hospitals in the region. Information sessions are held in libraries, churches and career centers.

How many we will reach:
- Year 1: about 72 adults in six cohorts (three nursing assistant and three phlebotomy), about 61 graduates and about 46 working in health care within 90 days, with 36 seats sponsored.
- Year 2: about 90 adults, about 77 graduates and about 58 working within 90 days, with 50 seats sponsored.
- Year 3: about 113 adults, adding a second Nurse Instructor and the medical assistant program, about 96 graduates and about 72 working within 90 days, with 66 seats sponsored.
- Year 4: about 141 adults, with a second Phlebotomy and Clinical Skills Instructor, about 120 graduates and about 90 working within 90 days, with 85 seats sponsored.
- Year 5: about 176 adults, with a third Nurse Instructor and a second Career Coach, about 150 graduates and about 112 working within 90 days, with 105 seats sponsored.
Over five years we expect to enroll about 590 adults and graduate about 500.

Who else benefits:
- Residents and patients. More trained staff means more timely, safer care for older adults and people with illnesses.
- Families. A health care worker earns a steady income, often with benefits, and many graduates become role models for their children.
- Employers. They gain trained, certified, committed staff and a partner who helps them keep new hires.
- The health care system. Fewer vacancies and lower turnover reduce strain and cost.
- The community. Graduates live and spend locally, and many continue to nursing and other licensed careers.

How we will size the need before we submit. We will add job openings, vacancy and turnover rates and typical wages for nursing assistants, phlebotomists and medical assistants in our region, the unemployment rate in our target neighborhoods and the number of adults on the workforce board's waiting list. These come from the Massachusetts Executive Office of Labor and Workforce Development, the U.S. Bureau of Labor Statistics, the Census Bureau and employer letters.

Competitive Landscape

Other options people have, and how we fit.

- Community college and vocational school programs. They offer valuable credentials and nursing pathways, often with college credit. They are usually offered during the day, can cost thousands of dollars, may require placement tests and rarely provide stipends, childcare help or job placement. We work with the community college, refer students both ways and aim to align our programs so that graduates can continue to nursing programs.
- Private career schools. Some offer fast training at a high price. Results vary. Our program is free to participants.
- Employer-run training. Many nursing homes run their own nurse aide programs, often tied to a job. This works well for their own hires but is not open to everyone, and the training can vary. We offer a shared pathway that several employers recognize.
- Red Cross and other short courses. Some offer nurse aide training, with fees and limited supports. We coordinate and refer.
- Online courses. Flexible for classroom learning, but state-approved nurse aide training requires hands-on skills and supervised clinical practice that online alone cannot provide.
- Home care and staffing agencies. They hire people for caregiving, sometimes without training. We encourage participants to get certified so they can choose among jobs and wages.
- Workforce board and American Job Centers. They fund training for eligible adults, and we are applying to be an approved provider so participants can use their funds with us.

The gap we fill. In our service area, no program combines free, state-approved, employer-aligned health care training in nursing assistant, phlebotomy and later medical assistant skills with stipends, childcare and transportation help, clinical placements, honest advice about certification, career coaching and 12 months of follow-up.

Our partners:
- Seven employers, including long-term care facilities, a hospital and a home care agency, which provide clinical sites, guest instructors, interviews and sponsored seats.
- The local workforce development board and its career centers, which refer participants and may sponsor seats.
- A community college, which provides adult education, college credit pathways and nursing programs.
- A union of health care workers and a nurse educator association, which advise us.
- A reentry organization, a veterans' group and several churches, which help recruit.
- The state agencies that approve and oversee nurse aide training.

Marketing & Sales Strategy

How participants, employers and supporters will find us and how we keep them engaged.

Reaching participants:
- The workforce board's career centers. Career advisors refer adults who are eligible and interested.
- Employers and clinical sites. Staff at nursing homes and hospitals tell volunteers, family members and workers about the program.
- Community partners. Churches, libraries, adult education programs, immigrant service organizations, veterans' groups and neighborhood centers share flyers and host information sessions, in English and the other main languages in our area.
- Graduates. Our best recruiters are nurses and nursing assistants who completed the program. They speak at information sessions and on social media, with their permission.
- A simple website and a text number in several languages, with start dates and an easy way to sign up.
- Social media, local radio and community newspapers featuring caregivers.
- Open house events. Twice a year, we invite the community to tour our skills lab and meet instructors and graduates.

Making it easy to join:
- Information sessions are held in the evening and on Saturdays, with a meal and childcare.
- Day and evening classes, so that people who work can attend.
- The program is free, and we tell applicants up front about the schedule, the stipend, background checks, immunizations and health screenings, and the state's certification rules.
- We do not require a diploma to start for the nurse aide program unless the state does, and we help applicants who need it with the application and with adult education.

Keeping participants engaged:
- Small cohorts that study and practice together.
- Hands-on work from the first week.
- If a participant misses two classes, the Program Coordinator calls the same week to solve the problem.
- A goal-setting conversation in week one and progress reviews every two weeks, with practice tests and tutoring for the exam.

Reaching employers:
- The Executive Director and Career Coach visit employers, explain the program and invite them to join our advisory group.
- Employers can interview students, join graduation and give feedback on the curriculum.
- We follow up after a hire and offer help with onboarding and retention.

Reaching supporters. Health employers, banks, businesses and individuals are invited to sponsor a seat, a cohort or the childcare fund. We share results twice a year with funders and partners as totals.

Outreach budget. Employer engagement and outreach are about $6,000 a year in Year 1, growing about 5% a year. The sign, outreach brochures and website are paid for once from startup money ($3,000).

Operations Plan

How the program will be carried out.

Timeline for Year 1:
- Months 1 to 3: Attorney review of the lease, clinical site and employer agreements and participant and privacy policies, sign the lease, build out the skills lab, hire the Program Director, the Nurse Instructor, the Phlebotomy and Clinical Skills Instructor and the Career Coach, buy and install the equipment, sign clinical site agreements and complete state approval for the nurse aide program.
- Month 4: Instructor training, orientation with clinical sites and recruiting and screening of applicants for the first cohorts.
- Months 5 to 8: First nursing assistant and phlebotomy cohorts run, including supervised clinical practice. Recruit the next cohorts.
- Months 8 to 12: Later cohorts run. First graduates take exams and begin their job search with the Career Coach. First employer results. First 12-month plans. Review of results, a year-end report to funders and planning for Year 2.

Space. A leased space of about 6,500 square feet near a bus line, with a classroom for 24, a patient care skills lab with sink stations, a phlebotomy lab, a small office and accessible restrooms. Skills lab and classroom space and utilities are about $36,000 a year in Year 1. Plumbing for sink stations, flooring, lighting, privacy partitions and accessibility upgrades are a one-time cost of $14,000, with a deposit and first month of rent of $9,000.

Equipment. We buy about $48,000 of equipment once at the start: a patient care skills lab with two hospital-style beds, adult and geriatric manikins, a patient lift, wheelchairs and vital signs equipment ($28,000), a phlebotomy lab with draw chairs, practice arms, tourniquets and supplies ($8,000), sixteen laptops, classroom furniture, a projector and whiteboards ($9,000), and handwashing sinks, sharps containers, an eyewash station, first aid supplies and secure storage ($3,000). After Year 1, we set aside about $4,000 to $9,000 a year to replace and add equipment. Skills lab supplies and equipment upkeep are about $14,000 a year in Year 1.

Staffing. In Year 1: an Executive Director who is a registered nurse, a Program Director who is a registered nurse, a Nurse Instructor, a Phlebotomy and Clinical Skills Instructor, a Career Coach and Employer Liaison and a part-time Program Coordinator. A second Nurse Instructor and the medical assistant program begin in Year 3, a second Phlebotomy and Clinical Skills Instructor in Year 4, and a third Nurse Instructor and a second Career Coach in Year 5.

State approval and standards. Nurse aide training programs must be approved by the state, and federal law sets minimum hours for classroom and supervised practical training, with the state free to require more. Instructors must meet requirements for education and experience. Phlebotomy and medical assistant rules differ by state and by certifying body. We confirm each requirement with the state and the certifying bodies before we enroll students, and we never enroll students in a program that is not approved. Our attorney and the Program Director review the approvals each year. Scrubs, exam, background check and health screening fees are about $16,000 a year in Year 1.

Safety and clinical practice. Students receive training in infection control and bloodborne pathogens, in line with Occupational Safety and Health Administration (OSHA) rules, and in safe patient handling before any practice. Students use practice arms in the lab. Supervised practice on real patients takes place only at approved clinical sites, under a qualified instructor, with the patient's or resident's consent, and in line with the site's and state's rules. Students are never left alone with patients, and they do not provide independent care. Students must meet clinical site requirements for immunizations, screenings and background checks, and we tell them in advance. Hepatitis B vaccination is offered or confirmed before exposure to blood. The program has a needlestick and exposure plan and student liability insurance. Clinical placement coordination and student liability coverage are about $10,000 a year in Year 1. In an emergency, staff call 911, and the clinical site's emergency plan applies at clinical sites.

Privacy. Students receive HIPAA training before clinical practice and sign a confidentiality agreement. Patient information stays with the clinical site under its own rules, and our records contain only each student's own training information. Student records are kept in a locked cabinet and a secure, password-protected system. We share a student's information with employers or funders only with the student's written permission, except where the law requires, and report results to funders only as totals.

Stipends. Stipends are paid in installments tied to attendance and are for training time, not wages. An attorney and our accountant review how stipends and training are treated for tax and benefit purposes before we begin. Participants who receive unemployment benefits are helped to ask the state agency how training affects their benefits and work search rules.

Fair chance and equal opportunity. We are open to people of every background and follow all laws on equal opportunity and reasonable accommodations. We are honest about which records and findings can bar certification or employment under state law, and we help people explore other options. We ask employers to follow fair chance practices within the limits of the law.

Support controls. Childcare, transportation and exam fees are paid directly to providers, transit agencies or testing bodies whenever possible. Each payment is approved by the Program Director and recorded, and the board reviews a list each quarter.

Insurance and records. We carry general liability, professional liability, student liability, property and cyber insurance, and workers' compensation once we hire. Insurance is about $14,000 a year in Year 1. Grant money is tracked separately so we can show each funder how their money was spent, and an outside accountant reviews our books every year.

Management & Organization

Who leads the organization.

Patricia Nwosu, RN, Executive Director. Patricia leads the organization, raises money, manages grants and employer and workforce board partnerships, supervises staff and reports to the board. She is a registered nurse who spent 12 years in long-term care nursing, 5 years as a nurse educator and co-led our pilot class. Planned salary: $60,000 a year.

Program Director (RN). Leads the curriculum and instruction, supervises instructors, manages clinical placements and state approvals, and oversees safety and exam preparation. Must be a registered nurse with teaching or training experience and meet state requirements. Planned salary: $76,000 a year.

Nurse Instructor (RN). Teaches the nursing assistant classroom and skills lab lessons and supervises students during clinical practice. Must be a registered nurse who meets the state and federal requirements for nurse aide training instructors. One in Years 1 and 2, two in Years 3 and 4 and three in Year 5, at a planned salary of $68,000 each. The Bay State Health Workforce Fund grant would support the first Nurse Instructor.

Phlebotomy and Clinical Skills Instructor. Teaches phlebotomy, and supports the medical assistant program from Year 3. Must hold current certification and clinical experience. One in Years 1 to 3 and two from Year 4, at a planned salary of $52,000 each.

Career Coach and Employer Liaison. Coaches participants, builds relationships with employers, arranges mock interviews and hiring events, advises on next steps and follows graduates for 12 months. One in Years 1 to 4 and two in Year 5, at a planned salary of $44,000 each.

Program Coordinator (part-time). Handles applications, attendance, stipends, childcare and transportation support, records and scheduling, about 25 hours a week. Planned pay: $26,000 a year.

Pay figures include payroll taxes and workers' compensation insurance.

Staff in each year: 6 paid staff in Years 1 and 2 (five full-time and one part-time), 7 in Year 3, 8 in Year 4 and 10 in Year 5.

Guest instructors and mentors. About 15 nurses, nursing assistants, phlebotomists and managers who teach sessions, give talks and mentor participants.

The board. A seven-member volunteer board approves the budget, reviews results twice a year and helps raise money. Board members serve three-year terms. The board's certified public accountant chairs the finance committee. The board's director of nursing and nursing assistant who became a nurse help keep the program grounded in what employers and participants need.

People who help us. An outside accountant who reviews our books every year, an attorney who reviews our lease, clinical site and employer agreements, an insurance agent who understands health care training, and an employer advisory group that meets each semester to tell us what skills they need and what is working.

Training. Instructors complete training in adult learning, trauma-informed teaching, infection control and safety before the first cohort, and attend at least two trainings a year.

Money management. Grant money is tracked separately for each funder. The Executive Director and a board member must both approve any payment over $2,500.

Milestones Narrative

Our goals for each year and how we will measure them.

- Year 1: Open the academy, run six cohorts (three nursing assistant and three phlebotomy) and enroll about 72 adults, with about 61 graduates and at least 75% of graduates working in health care within 90 days. A balanced budget of about $523,500, with a small surplus of about $15,700. 6 paid staff.
- Year 2: Enroll about 90 adults and graduate about 77. Begin 12-month follow-up with Year 1 graduates and hold the first employer advisory summit. A balanced budget of about $548,500, with a small surplus of about $15,200. 6 paid staff.
- Year 3: Add a second Nurse Instructor and the medical assistant program, enrolling about 113 adults and graduating about 96. A balanced budget of about $648,500, with a small surplus of about $15,500. 7 paid staff.
- Year 4: Add a second Phlebotomy and Clinical Skills Instructor, enrolling about 141 adults and graduating about 120. Invite graduates to mentor new participants. A balanced budget of about $738,500, with a small surplus of about $16,500. 8 paid staff.
- Year 5: Add a third Nurse Instructor and a second Career Coach, enrolling about 176 adults and graduating about 150, with sponsored seats covering about 35% of our budget. Report five years of results, including how many graduates moved on to nursing programs. A balanced budget of about $897,000, with a small surplus of about $17,600. 10 paid staff.

What we measure:
- Applications, enrollment, attendance and completion by cohort.
- Exam attempts and pass rates for the state nurse aide exam and national certification exams.
- Employment in health care at 90 days, 6 months and 12 months, wages and hours, and retention.
- Advancement to a next credential or role, such as a nursing program.
- Participant, clinical site and employer satisfaction.
- Seats sponsored by employers, the workforce board and the state.
- Results by gender, race and background so that we can find and fix gaps.
- Stipend and support payments, and the cost per graduate and per placement.

How we review results. The Program Director reviews attendance, practice test results and clinical evaluations every week. After each cohort, staff, instructors and our employer advisory group review the results and change what is not working. Twice a year, the board reviews results and we share them with funders and partners as totals. Every number in this plan is a goal, and we will report what really happens.

Funding Request

What we are asking for, and how the money will be used. Our request: $100,000 from the Bay State Health Workforce Fund for one Nurse Instructor, participant stipends, childcare and transportation support, and scrubs, exam and screening fees, for July 2027 through June 2028.

The request is spread across these budget lines:
- Personnel: Nurse Instructor (RN) salary, $68,000.
- Other: Participant training stipends, $18,000 (other funds add $25,200).
- Other: Childcare and transportation support, $8,000 (other funds add $10,000).
- Other: Scrubs, exam, background check and health screening fees, $6,000 (other funds add $10,000).

Other money in the program. Sponsored seats, other grants and local donors pay the other $45,200 of those lines, plus the Executive Director's salary ($60,000), the Program Director ($76,000), the Phlebotomy and Clinical Skills Instructor ($52,000), the Career Coach and Employer Liaison ($44,000), the part-time Program Coordinator ($26,000), clinical placement coordination and student liability coverage ($10,000), skills lab supplies and equipment upkeep ($14,000), skills lab and classroom space and utilities ($36,000), employer engagement and outreach ($6,000), insurance ($14,000) and evaluation, data and administration ($15,000).

Year 1 budget: about $523,500, planned to balance with a small surplus (about $15,700 after the yearly wear on equipment). Year 1 money coming in: grants $390,500 (this request plus other grants we are applying for), health employer, workforce board and state sponsored seats $108,000 (36 seats at $3,000 each) and donations and local sponsors $25,000. Year 1 costs: Executive Director $60,000; Program Director $76,000; Nurse Instructor $68,000; Phlebotomy and Clinical Skills Instructor $52,000; Career Coach and Employer Liaison $44,000; Program Coordinator $26,000; participant training stipends about $43,200 ($600 for each of 72 participants); childcare and transportation support about $18,000; scrubs, exam, background check and health screening fees about $16,000; clinical placement coordination and student liability coverage about $10,000; skills lab supplies and equipment upkeep about $14,000; skills lab and classroom space and utilities about $36,000; employer engagement and outreach about $6,000; insurance about $14,000; evaluation, data and administration about $15,000; and about $14,800 a year for the wear on equipment.

About sponsored seats. A health employer, the workforce board or a state training program may pay $3,000 for a seat when they expect to consider the graduate or when the participant is eligible for workforce funding. A sponsor pays for training, not for a hire, and a participant is free to apply anywhere. Approval as a workforce training provider and as a nurse aide program can take months, so Year 1 is planned with 36 sponsored seats out of 72, growing to 105 out of 176 by Year 5. The amounts are planning estimates, not promises. Payments often arrive weeks after we bill, so we plan for about $36,645 owed to us at the end of Year 1.

One-time startup costs. Startup costs of $97,000 are paid once from startup money, not from the yearly budget: $48,000 of equipment (the patient care skills lab, the phlebotomy lab, laptops and classroom furniture, and sinks and safety supplies), $14,000 for plumbing, flooring, lighting, partitions and accessibility upgrades, $9,000 for the lease deposit and first month of rent, $6,000 for the opening supply of linens, gowns, gloves and practice supplies, $4,000 for state program approval fees, $7,000 for an attorney's review of the lease, clinical site and employer agreements, participant and privacy policies and for accounting setup, $3,000 for the sign, brochures and website, and $6,000 for background checks, instructor training and the first insurance payment.

How we got our startup number. The Funding Need Calculator in this plan adds the startup costs ($97,000), the cash we need to cover the wait for the first payments (about $11,300) and a cash cushion of about $124,600, which is about three months of Year 1 costs. That comes to $233,000. We start with $30,000 of our own savings and $215,000 in startup support from a community foundation, two health employers and our board, $245,000 in all, which covers that amount with room to spare.

The next five years. Our budget grows from about $523,500 in Year 1 to about $897,000 in Year 5. Grants are planned at $390,500, $366,500, $408,500, $431,500 and $520,000 in Years 1 to 5. Sponsored seats grow from $108,000 to $315,000, and donations and local sponsors grow from $25,000 to $62,000. We add a second Nurse Instructor and the medical assistant program in Year 3, a second Phlebotomy and Clinical Skills Instructor in Year 4, and a third Nurse Instructor and a second Career Coach in Year 5. Grants fall from about 75% of our income in Year 1 to about 58% in Year 5.

Savings. We plan to keep several months of costs in savings. The lowest year-end balance in the plan is about $185,700, at the end of Year 1.

After the grant. Our plan is for sponsored seats to cover a growing share of the cost, because health employers get certified, committed staff and lower turnover, and for employers, banks and businesses to sponsor seats and cohorts. We will also apply to state and federal health workforce funds, and share our curriculum and coaching model with other programs for a fee in later years.

Risks and how we will handle them:
- State approval takes longer than planned. We apply early, start with the phlebotomy cohorts and keep a cash cushion.
- Too few applicants or too many dropouts. We recruit through many channels, hold information sessions with meals and childcare, call after two missed classes and build in supports, including exam tutoring.
- A participant is not eligible to be certified because of a record. We advise every applicant honestly before enrollment and help them explore other options.
- Graduates cannot find jobs. We build the program with employers, host hiring events and offer coaching for 12 months. We do not promise jobs.
- A safety incident, such as a needlestick or a lifting injury. We train every participant, supervise all practice, offer vaccination, follow an exposure plan and carry insurance.
- Instructors are hard to hire. We start recruiting early, offer competitive pay and partner with employers to share nurse educators.
- A grant ends. We keep savings, grow sponsored seats and donors each year.

If you are just starting. A new organization can begin before it has its own 501(c)(3) status through a fiscal sponsor: an established nonprofit that receives grants for you and passes them to your program, usually for a fee (commonly around 5% to 10% of the grant, sometimes more; ask before you agree). Another way is to start smaller: one phlebotomy cohort of about 10 participants in borrowed classroom space with a certified instructor and one clinical site, tracked carefully, while you complete state approval for a nurse aide program. Strong results from a small start make larger grants easier to win.

Appendix Notes

Documents to attach with this proposal:

- Your IRS 501(c)(3) determination letter, or your fiscal sponsor agreement.
- Your most recent financial statements and your current year budget.
- A list of your board members and what each one does.
- Licenses, certifications and resumes for your Executive Director, Program Director and Instructors.
- Proof of state approval of your nurse aide training program, or proof you have applied.
- Your curriculum outlines and the certifications each program leads to.
- Letters from employers and clinical sites about clinical placements, interviews, sponsored seats and hiring plans.
- A letter from the workforce board, or proof you have applied to be an approved training provider.
- The letter of intent for the lease, or a letter from the landlord.
- Results from your pilot class, shown as totals.
- Your participant application, stipend policy, attendance policy, immunization and background check requirements, exposure plan and incident report form.
- Proof of liability, student liability and workers' compensation insurance, or quotes.
If you don't have any of this yet, no worries - let's continue.

The assumptions behind our numbers (change them in the Financials section to match your own):
- Grant Revenue: $390,500 in Year 1, then $366,500, $408,500, $431,500 and $520,000.
- Health Employer, Workforce Board and State Sponsored Seats: $3,000 per sponsored seat. 36 seats in Year 1 ($108,000), then 50 ($150,000), 66 ($198,000), 85 ($255,000) and 105 ($315,000).
- Donations and Local Sponsors: $25,000 in Year 1, growing to $62,000.
- Participants: 72 in Year 1 (six cohorts of 12), then 90, 113, 141 and 176, with about 85% completing.
- Pay (a full year, per person, including payroll taxes and workers' compensation): Executive Director $60,000, Program Director $76,000, Nurse Instructor $68,000 (one in Years 1 and 2, two in Years 3 and 4, three in Year 5), Phlebotomy and Clinical Skills Instructor $52,000 (one in Years 1 to 3, two from Year 4), Career Coach and Employer Liaison $44,000 (one in Years 1 to 4, two in Year 5), Program Coordinator (part-time) $26,000.
- Other yearly costs in Year 1: Participant Training Stipends $43,200 ($600 per participant, growing about 25% a year), Childcare and Transportation Support $18,000, Scrubs, Exam, Background Check and Health Screening Fees $16,000, Clinical Placement Coordination and Student Liability Coverage $10,000, Skills Lab Supplies and Equipment Upkeep $14,000, Skills Lab and Classroom Space and Utilities $36,000, Employer Engagement and Outreach $6,000, Insurance $14,000, Evaluation, Data and Administration $15,000. The other costs grow between 4% and 25% a year.
- Equipment: $48,000 at the start, then $4,000 to $9,000 a year.
- Startup costs: $97,000, paid once from $245,000 in startup money.
- About 7% of each year's income is still owed to us at year end.
- Tax: none, as a nonprofit.
- Every dollar amount is an estimate. Replace them with your own quotes and real budget.

Startup Costs