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This Pre-Application form is required as the first step in applying for funding from Partners for Health Foundation. Following internal review, you will be invited to complete a full application, or notified that your proposal will not be considered. Notifications are scheduled for the end of July.

Please complete this form and submit it no later than Monday, July 22, 2024.

We may contact you during the review period if we have any questions.

Please note that this form is for requests totaling more than $15,000. Small Grant Requests (up to $15,000) 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 legal name and name it's commonly known by

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* 2. Organization Information (Address, telephone number, website, and social media handles)

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* 3. Pre-App Form Contact (Name and title)

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* 4. Pre-App Form Contact Email

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* 5. Pre-App Form Contact Phone

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

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* 7. Estimated duration of the grant request (In months, 12 to 36)

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* 8. Total Amount Requested

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* 9. Please provide a 1 - 2 paragraph summary about your proposed funding request. Feel free to use bullet points.

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* 10. Where will the work take place? (Please see PfH communities served. Statewide organizations that support local coalitions or advocate for statewide policy change to advance health equity and social justice may also be eligible for funding). If applicable, please describe any specific geographic focus of your work (ex. neighborhoods)

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* 11. Please elaborate on how this request aligns with the themes and priorities we have outlined on our website.

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