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Community Connection Fund Application
Supporting grassroots ideas that strengthen connection, community impact, and engagement.
*
1.
Name
(Required.)
*
2.
Phone Number
(Required.)
*
3.
Email Address
(Required.)
4.
City and Province
5.
How would you best describe yourself?
Volunteer
Fire Fighter Partner
Person/Family member with a neuromuscular disorder
Researcher/Clinician/Health Care Practitioner
Other
6.
We would love to hear more about your event/initiative. What is your idea?
7.
Please share the primary goal of your event/initiative (check all that apply):
Build community connection/networking
Strengthen support for people/families living with neuromuscular disorders
Increase awareness and education
Build or strengthen relationships
Support fundraising
Other
*
8.
Who will directly benefit from your event/initiative?
(Required.)
People/families with neuromuscular disorders
Volunteers
Fire Fighter partners
Researcher/Clinicians/Health Care Practitioners
Other
*
9.
Will this event/initiative be accessible? Please describe the steps you have taken to ensure all can participate safely.
(Required.)
10.
Are there any safety risks or concerns that Muscular Dystrophy Canada should be aware of?
11.
Estimated number of people this event/initiative will serve:
1-10
11-25
26-50
50+
Other
12.
Total amount requested (maximum $500):
13.
Please share a breakdown of the expenses.
14.
When would you like to host your event/initiative?
15.
Are you willing to share photos, quotes, or a reflection after your event/initiative?
Yes
No
16.
A member of our team will reach out for more information. How can we best reach you?
Phone
Email
