Community Partnership Fire Starter Birth Equity Initiative Funding Survey

Letter of Intent

The Ohio Collaborative to Prevent Infant Mortality (OCPIM) announces the Community Partnership Fire Starter Birth Equity Funding Initiative. The targeted OCPIM regional-funded activities will begin Monday, May 1, 2023, with completion by Wednesday, May 31, 2023. All Letters of Intent are due on Friday, February 17, 2023.

You must submit an LOI to be eligible for funding. Funding applications will be released on Monday, February 27, 2023, and will be due by Monday, March 13, 2023. The LOI must include the following information:

1.What is the one thing your team can do in your community to help a baby survive and thrive beyond their first birthday?

2.How would you do the one thing?

3.What’s the desired outcome, and how will you know that the one thing you plan to do will achieve it?

4.Who will be your audience? (Target number of people to be reached 30)

5.What county in Ohio

6.Lead Team Member

Name

Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

County

Email Address

Phone Number

7.Team Member (Required)

Name

County

Email Address

Phone Number

8.Team Member (Required)

Name

County

Email Address

Phone Number

9.Team Member (Optional)

Name

County

Email Address

Phone Number

10.Team Member (Optional)

Name

County

Email Address

Phone Number

11.Amount Requested (Up to $1,500.00)

12.Are you a member of OCPIM

Yes