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A Pre-Application survey is required as the first step in applying for funding from Partners for Health Foundation. Please complete this form and submit it no later than
Monday, April 17th, 2023. 

Following internal review, you will be invited to complete a full application, or notified that your proposal will not be considered. We may contact you during the review period if we have any questions. 

Please note that this form is for requests totaling more than $10,000. Small Grant Requests (under $10,000) are accepted on a rolling basis, and can be accessed in our grants management system.

We ask that you read through our funding guidelines before submitting your funding request.  

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* 1. Organization Name

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* 2. Main Contact (Name and title)

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* 3. Contact Email

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* 4. Contact Phone

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* 5. Total Amount Requested

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* 6. Estimated Duration of the funding request (Months/Years)

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* 7. Select which type of funding you are seeking:

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* 8. For General Operating funding request, use bullets to describe how your organization is in alignment with the core components of Partners for Health values: 

a. focusing on health equity

b. working to improve how services are provided, based on feedback from constituents served (i.e., viewing issues at their source through a systems-perspective or addressing social determinants of health)

c. collaborating with others to strengthen service provision, alleviate gaps in services, and leverage dollar and other resources

d. using data to drive decision making (i.e., how will you know that your constituents are benefitting from your work?)

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* 9. Please provide a 1 - 2 paragraph summary about your proposed funding request, and how it will serve the community. 

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