Mini-grant Application
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1. HealthSTAT Mini-Grant Application

Thank you for applying for a HealthSTAT mini-grant. A HealthSTAT representative will notify you once we review your application.

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1. Please provide your information:

Please provide your information: Name:
City:
Email Address:
Phone Number:

2. What school and degree program?

What school and degree program?

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3. Type of Event

	Coffee Hour	Workshop	Lunchtime Talk	Event
Education	*Type of Event Education Coffee Hour	Education Workshop	Education Lunchtime Talk	Education Event
Service	Service Coffee Hour	Service Workshop	Service Lunchtime Talk	Service Event
Advocacy	Advocacy Coffee Hour	Advocacy Workshop	Advocacy Lunchtime Talk	Advocacy Event

Other (please specify)

4. Title of Event

Title of Event

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5. Short Description of Project

Short Description of Project

6. If you have community partner(s) please provide their information.

Community Partner(s)

If you have community partner(s) please provide their information. Community Partner(s) Name:
Organization:
Email Address:
Phone Number:

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7. Location of Project:

Location of Project:

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8. Timeline of Preparation and Completion of Project:

Timeline of Preparation and Completion of Project:

9. Budget:

Please indicate how much money you are requesting and what you will use it for.

Budget: Please indicate how much money you are requesting and what you will use it for.

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10. Which of HealthSTAT's organizational objectives does this project meet?

Which of HealthSTAT's organizational objectives does this project meet? Engages students in education, advocacy, or service

Addresses social determinants of health

Focuses on health disparities and underserved populations

Focuses on statewide public health efforts

Has an effect on Georgia

Engages students in leadership development

Fosters interdisciplinary collaboration

Fosters geographic collaboration

Thank you for your proposal, a HealthSTAT leader will be in touch with you regarding potential approval and further collaboration.

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Mini-grant ApplicationExit this survey

1. HealthSTAT Mini-Grant Application

*1. Please provide your information:

2. What school and degree program?

*3. Type of Event

4. Title of Event

*5. Short Description of Project

6. If you have community partner(s) please provide their information.Community Partner(s)

*7. Location of Project:

*8. Timeline of Preparation and Completion of Project:

9. Budget:Please indicate how much money you are requesting and what you will use it for.

*10. Which of HealthSTAT's organizational objectives does this project meet?