Community Benefit Grant Application

Please complete application form below by 4 p.m. on the dates below: 

  • March 8
  • May 3
  • September 6
  • November 15

Applicants will be notified within four weeks if they will receive a grant.

The following documentation is required:

  • IRS letter of determination 501(c)(3)
  • Names of your organization's board members, terms of office and compensation, if any
  • List of key staff members and your organizational chart
  • Completed grant application form
  • One example of each of the following (if available):
    • Annual report 
    • Organizational brochure
    • A balance sheet and income statement covering your organization's most recently completed fiscal year

Please email all of the documentation to: bjgrear@Premierhealth.com

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Mailing Address

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Executive Director/CEO

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Select a title *

Contact for Application

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State the purpose of your proposal/request in no more than two sentences.

Community health priority that best applies to your proposal *

Please select between 1 to 3

Funding Category *
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Define the target population for your initiative and how it will reach those that are most vulnerable to the health issue you are trying to improve.

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What evidence based strategies are being utilized and how will it improve the health of the target population? How will you measure the health improvement?

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Identify the collaborating entities associated with this initiative. Please note any financial and/or in-kind contributions to your initiative.

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Define your alternative plan if funding is not granted from Premier Health.

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Define your timetable for your initiative/program development, implementation, and measurement.

Certify Entry *