Upcoming application deadlines:
  • May 24, 2021 - notification by July 13
  • August 16, 2021 - notification by Sept. 15
  • October 1, 2021 - notification by Nov. 3
The application's functionality has been updated to allow saving and returning to your previous responses.  Please note, in order for this feature to work properly, you must consistently use the same device and the same web browser you used to start the application, as Survey Monkey stores a cookie on your browser that remembers your survey responses.  We recommend saving a copy of your responses in another format. 

The bottom of the page lists the additional documents required and instructions to submit your finalized application. 

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1. Organization

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2. Tax ID#

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3. Website Address

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4. President or Chief Executive Officer

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5. Organizational Mission

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6. Name of Program Requesting Funding

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7. Funding Amount Requested

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8. What is the problem or need addressed by the program?

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9. Contact Person for Application

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10. Signature of Authorized Person
My signature certifies the organization named above has tax exemption under Internal Revenue Service Code Section 501(c)(3). My name in this space indicates I am authorized to sign on behalf of the applying organization.

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11. Indicate the Baptist Health priority and/or the Community Health Needs Assessment prioritized need the program addresses (select all that apply)

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12. Who is your targeted population?

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13. What are the goals and objectives of your program and how does it fit into your organization's overall mission?  Please utilize S.M.A.R.T. attributes.

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14. What the specific measures or data that will demonstrate impact/success?  How will you collect the data?  

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15. If program has been operational in the past, provide outcomes achieved during the previous year. 

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16. What are the titles and qualifications of staff implementing the program?

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17. Identify the biggest challenges or obstacles to successfully implementing the program. How do you plan to overcome them? Are collaborations necessary? 

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18. How many years funding are you requesting?  If more than one, please explain.

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19. If approved, how do you plan to sustain the program once Baptist Health funding ceases?

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20. Does the organization have a board-approved succession plan its executive leader?  Baptist Health funding is contingent upon a board-approved succession plan for its executive leader.

Additional Documents Required:
  • Organizational budget
  • Program budget - under revenue, please  include other financial requests, providing funder names, amounts and status (seeking or secured), including the Baptist Health request
  • List of board members with affiliations and demographics/ethnicity
  • Board-approved succession plan or signed certification of board-approved succession plan
  • Copy of the tax-exempt status determination letter from the Department of the Treasury, IRS
  • Copy of most recently filed IRS Form 990
  • Most recent annual report (if available)
To submit your application:
1. ensure the finalized version is saved in Survey Monkey
2. prepare an email to lynn.sherman@bmcjax.com, copying jennifer.donahoo@bmcjax.com, with the subject line: "Your organization's name - submitting Strategic Investment application"

For questions or concerns, please contact:
Lynn Sherman, Director of Community Engagement for Social Responsibility
lynn.sherman@bmcjax.com or 904.202.5112

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