WORKSHEET 3.1A: Statement of Need Questionnaire Use the filled-out Worksheet 3.1B in the book as an example to follow as you complete this questionnaire. Who? Where? When? What? Why? Evidence of Problem Impact If Problem Is Resolved? Who is in need (people, animals, land, etc.)? The community of children whose parents undergoing cancer treatment are in need of the services the Children’s Academy of Pinellas has to offer. Expanding the childcare program to include complimentary nutritious meals will not only encourage proper nutrition for children of the academy, but help alleviate some of the parental or caregiver stress that often accompanies those undergoing cancer treatment. Where are they? The population of children being served at the Children’s Care Academy live within the central west portion of Pinellas County, Florida. When is the need evident? Children can be at the academy for several hours a day, often during breakfast, lunch and or dinner times, requiring the need for children to receive a nutritious meal. Some parents may not have the time, energy or financial means to provide nourishing food for their children during their stay at the academy. The need is evident for each child as long as the parent or caregiver is undergoing cancer treatment. What is the need? The need for expanding the outreach program is two-fold; to ensure children are receiving nutritious meals and to help ease some parental responsibilties while undergoing cancer treatment. Many parents or caregivers do not have family members or friends available to help care for children during time-consuming cancer treatment sessions. Traditional daycare facilities are fashioned to accommodate working parents requiring payment for services on a continual basis regardless of how often the children attend. Daycare facilities are also very expensive and do not provide nutritious food programs on a complimentary basis. The Children’s Care Academy is designed to care for children coinciding with treatment schedules on a complimentary basis. Pinellas County is home to a large population of single-working parents struggling to make ends meet. Single families generally face greater challenges in everyday life with less income and less family support. Demanding cancer treatment schedules can further complicate the single-family structure resulting in an even greater need for the resources offered by the Children’s Care Academy of Pinellas. Why does this need exist? Parents or caregivers undergoing cancer treatment face a multitude of challenges. Those undergoing treatment become all consumed with vigorous treatment schedules and learning to deal with the aftermath of some of the physical and emotional side effects resulting from treatment. Treatments such as radiation and chemotherpay can take a toll on the body resulting in nausea, vomiting, weakness, loss of appetite and fatigue; leaving little energy to perform even the easiest tasks at home, such as prepari.

1. WORKSHEET 3.1A: Statement of Need Questionnaire
Use the filled-out Worksheet 3.1B in the book as an example to
follow as you complete this questionnaire.
Who? Where? When?
What? Why?
Evidence of Problem
Impact If Problem Is Resolved?
Who is in need
(people, animals, land, etc.)?
The community of children whose parents undergoing cancer
treatment are in need of the services the Children’s Academy of
Pinellas has to offer. Expanding the childcare program to
include complimentary nutritious meals will not only encourage
proper nutrition for children of the academy, but help alleviate
some of the parental or caregiver stress that often accompanies
those undergoing cancer treatment.
Where are they?
The population of children being served at the Children’s Care
Academy live within the central west portion of Pinellas
County, Florida.
When is the need evident?
Children can be at the academy for several hours a day, often
during breakfast, lunch and or dinner times, requiring the need
for children to receive a nutritious meal. Some parents may not
have the time, energy or financial means to provide nourishing
food for their children during their stay at the academy. The
need is evident for each child as long as the parent or caregiver
is undergoing cancer treatment.
What is the need?
The need for expanding the outreach program is two-fold; to

2. ensure children are receiving nutritious meals and to help ease
some parental responsibilties while undergoing cancer
treatment. Many parents or caregivers do not have family
members or friends available to help care for children during
time-consuming cancer treatment sessions. Traditional daycare
facilities are fashioned to accommodate working parents
requiring payment for services on a continual basis regardless
of how often the children attend. Daycare facilities are also very
expensive and do not provide nutritious food programs on a
complimentary basis. The Children’s Care Academy is designed
to care for children coinciding with treatment schedules on a
complimentary basis.
Pinellas County is home to a large population of single-working
parents struggling to make ends meet. Single families generally
face greater challenges in everyday life with less income and
less family support. Demanding cancer treatment schedules can
further complicate the single-family structure resulting in an
even greater need for the resources offered by the Children’s
Care Academy of Pinellas.
Why does this need exist?
Parents or caregivers undergoing cancer treatment face a
multitude of challenges. Those undergoing treatment become all
consumed with vigorous treatment schedules and learning to
deal with the aftermath of some of the physical and emotional
side effects resulting from treatment. Treatments such as
radiation and chemotherpay can take a toll on the body resulting
in nausea, vomiting, weakness, loss of appetite and fatigue;
leaving little energy to perform even the easiest tasks at home,
such as preparing a nutritious meal for the children.
What evidence do you have to support your claim
According to the 2000 census data the incidence rate for newly
diagnosed cancer cases in Pinellas County, Florida equal 109.2

3. per every 100,000 out of a total of 922,261 residents between
the years 2008 and 2011. These statistics include all cancer sites
and races for both sexes under the age of fifty (“National
Cancer Institute,” 2015).
Many of these newly diagnosed cancer cases will require the
childcare services of the Children’s Care Academy during the
course of cancer treatment.
There have been documented instances at the Children’s Care
Academy where children have arrived at the facility hungry. We
found many of the children coming to the academy without
having had a proper meal before arriving. The academy began
researching the reasoning behind the hunger and found the
parent or caregiver was just not up to preparing a proper meal
due to the ill effects of their cancer treatment. This realization
led to the notion of launching the Quick Bites Café to help
further our service to the community.
References
National Cancer Institute. (2015). Incidence RateTable.
Retrieved from
http://statecancerprofiles.cancer.gov/incidencerates/index
What will occur if the needs are met? What will be different –
and how?
The two-fold need for expanding the outreach program will be
met through the provisons the Quick Bite Café will offer.
Children attending the academy will be guaranteed at least one
nutritious meal a day while affording a bit of respite for the
parent or caregiver for the duration of their cancer treatment.
How is the need linked to your organization?
The Children’s Care Academy of Pinellas is situated to care for
children; providing nutritious meals will only help further that
care to encourage health, happiness and healing.
In addition to the childcare, tutoring and counseling services we
currently provide, including nutritious meals will offer a unique

4. program like no other. Success of the Quite Bites Café will
pave the way for additonal facilites to serve a wider opportunity
of those in need.

6. Winning Grants Step by Step,Fourth Edition. Copyright © 2013
by John Wiley & Sons, Inc. All rights reserved.
The notion of a childcare facility proposing a complimentary
food program is a foreign concept offering a unique service to a
specific community in need. The complimentary nutritious food
program proposed by the Children’s Care Academy of Pinellas
will fulfill a huge need in the community for all parents or
caregivers undergoing cancer treatment regardless of family
structure or income. According to the 2000 census data, the
incidence rate for newly diagnosed cancer cases in Pinellas
County, Florida equal 109.2 per every 100,000 out of a total of
922,261 residents between the years 2008 and 2011. These
statistics include all cancer sites, race and ethnicity for both
sexes under the age of fifty (“National Cancer Institute,” 2015).
Many of these newly diagnosed cancer cases will undergo
cancer treatment and would benefit substantially from the food
service program proposed by the Children’s Care Academy of
Pinellas.
Treatment schedules can be rigorous, time consuming and
unsettling resulting in the reliance on outside resources.
Pinellas County is home to a large population of single-working
parents struggling to make ends meet. Single families generally
face greater challenges in everyday life with less income and
family support. Demanding cancer treatment schedules can
further complicate the single-family structure resulting in an

7. even greater need for outside assistance. The following
narrative was relayed by a current pro-bono staff member of the
Children’s Care Academy. Talking with D.Thomas (personal
communication, May 15, 2015)…
“I was a single-parent raising a daughter on my own without the
help of family and friends. When my daughter was 18 months
old I went back to school to further my education. Upon
graduation I became gainfully employed in my new career, but
still needed to work two jobs to make ends meet. I was
diagnosed with stage III breast cancer the year my daughter
turned four. I was devastated physically, emotionally and
financially. After my double mastecotmy I started a rigorous
treatment plan with radiation and chemotherapy. Treatment was
grueling and greatly diminished my ability to properly care for
my daughter. I was struggling to find childcare during my
treatment sessions and was physically inept to prepare a
nourishing meal for my daughter. Today, I am a six-year cancer
survivor. I currently donate my counseling services to the
Children’s Care Academy of Pinellas to help children whose
parents are undergoing cancer treatment. I applaud their heart
for community outreach and will continue to strive in helping
the program expand its services to help change lives.”
Recently, the Children’s Care Academy staff became
increasingly aware that children were arriving at the academy
hungry, regardless of the time they were brought to our care.
We conducted a simple impromptu survey with the children and
their parent or caregiver and found that the parent or caregiver
was not always physically able to prepare a proper meal due to
the ill effects of the cancer treatment. This realization led to
the notion of launching the Quick Bites Café to help further our
service and dedication to the community.
Children with parents or caregivers undergoing cancer
treatment residing in the central west portion of Pinellas
County, Florida have the unique opportunity of being served by
the Children’s Care Academy of Pinellas through
complimentary childcare including academic tutoring and

8. counseling services. Expanding the academy’s childcare
program to include complimentary nutritious meals will not
only encourage proper nutrition for children but help alleviate
some of the stress for parents or caregivers that often
accompanies the demands of treatment.
Children can be in the care of the academy for several
hours a day, often during breakfast, lunch and or dinner times,
requiring the need for children to receive a nutritious meal.
Some parents may not have the time, energy or financial means
to provide a nourishing meal for their children while undergoing
treatment resulting in a hungry child. The academy feels the
addition of a food program will help fill this void for as long as
the parent or caregiver is undergoing treatment.
Traditional daycare facilities are designed to accommodate
working parents requiring payment for services on a continual
basis regardless of how often the children attend. Daycare
facilities are also very expensive and do not provide nutritious
food programs on a complimentary basis. The Children’s Care
Academy is fashioned to care for children coinciding with
treatment schedules on a complimentary basis.
Situated to care for children, expanding the Children’s
Care Academy’s outreach to include a food program will fullfill
the two-fold need through the provisons the Quick Bite Café
will offer. Children attending the academy will be guaranteed at
least one nutritious meal a day while affording a bit of respite
for the parent or caregiver to encourage enhanced health,
happiness and healing. Success of the Quite Bites Café will
help pave the way for additonal Children’s Care Academies
providing a wider opportunity to serve those in need.

9. References
National Cancer Institute. (2015). Incidence rate table.
Retrieved from
http://statecancerprofiles.cancer.gov/incidencerates/index
WORKSHEET 3.1: Statement of Problem Questionnaire
Who? Where? When?
What? Why?
Evidence of Problem
Impact If Problems Resolved?
Who is in need
(people, animals, land, and so forth)?
Why does this problem exist?
What evidence do you have to support your claim?
What will occur if the needs are met? What will be different –
and how?

10. Where are they?
(General: city/state; and specific: neighborhood, geography)
What is the problem?
(Get specific)
How is the problem linked to your organization?

11. When is the problem evident?

12. Winning Grants Step by Step,Third Edition. Copyright © 2008
by John Wiley & Sons, Inc. All rights reserved.
Problem statements should provide evidence of a problem or
issue that exists in a given population.
This is a two-part assignment:
First, complete the Statement of Problem Questionnaire. You
can use the electronic version and save with your answers filled
in or you can submit a separate answer sheet.
Next, use this information to write the Problem Statement. See
the example on pages 34-35.
Remember, use the book only as a guide. All worksheets and
written submissions NEED to contain great amount of details
where appropriate. One or two sentence responses in worksheets
will likely result in a poor grade, so include lots of details.