Application for Legal and Policy Assistance to Address Racial Health Equity

2024-2025 Cohort

Application Guidelines: Click here to view/download (opens in new window)

Application Deadline: September 9, 2024

Question Title

* Organization Name

Question Title

* Organization Type (e.g., health agency, community-based organization, non-profit, advocacy group)

Question Title

* Tribal Nation

Question Title

* City

Question Title

* State/Territory

Question Title

* County

Question Title

* How would you describe the community or communities that you serve?

Question Title

* What are your racial equity commitments and goals?

Question Title

* A short description of the project/issue

Question Title

* Describe the community of focus, any law or policy barriers you have encountered, and law and policy questions you have.

Question Title

* Specific legal technical assistance requested from the Network for Public Health Law

Question Title

* The Network has limited funds to offer a stipend to honor community and staff time to support the participation of under-resourced organizations. Stipend recipients will be required to fill out an I-9 form.

If you are interested in a stipend, please explain how it will support your participation.

Question Title

* Point Person #1

Name

Organization

Title

Address

Tribal Nation (or N/A)

State

City/Town

ZIP Code

Email Address

Phone Number

Question Title

* Point Person #2

Name

Organization

Title

Address

Tribal Nation (or N/A)

State

City/Town

ZIP Code

Email Address

Phone Number

Thank you!

Application for Legal and Policy Assistance to Address Racial Health Equity

Question Title

* Organization Name

Question Title

* Organization Type (e.g., health agency, community-based organization, non-profit, advocacy group)

Question Title

* Tribal Nation

Question Title

* City

Question Title

* State/Territory

Question Title

* County

Question Title

* How would you describe the community or communities that you serve?

Question Title

* What are your racial equity commitments and goals?

Question Title

* A short description of the project/issue

Question Title

* Describe the community of focus, any law or policy barriers you have encountered, and law and policy questions you have.

Question Title

* Specific legal technical assistance requested from the Network for Public Health Law

Question Title

* The Network has limited funds to offer a stipend to honor community and staff time to support the participation of under-resourced organizations. Stipend recipients will be required to fill out an I-9 form. If you are interested in a stipend, please explain how it will support your participation.

Question Title

* Point Person #1

Question Title

* Point Person #2