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machi_grant

Maternal Health MACHI Grant Idea Form

Submit the information below to be considered for a Member and Community Health Improvement (MACHI) grant. Submissions should clearly explain how your project or program will help reduce racial disparities in maternal health. If selected, you will be invited to complete a full application.  

Funding decisions will be announced in the fall. Programs or projects that are not selected may be considered for future funding opportunities.
 

Submit the information below to be considered for a Member and Community Health Improvement (MACHI) grant. Submissions should clearly explain how your project or program will help reduce racial disparities in maternal health. If selected, you will be invited to complete a full application.  

Funding decisions will be announced in the fall. Programs or projects that are not selected may be considered for future funding opportunities.
 

Requesting Organization

Requesting Organization null

Benefiting Organization

Benefiting Organization null

About the Benefiting Organization

About the Benefiting Organization

Federal Tax Identification Number

Federal Tax Identification Number Also known as Employer Identification Number null

Contact Name

Contact Name First and Last Name null

Phone Number

Phone Number ###-###-#### null

Street Address 1

Street Address 1 Street Address/P.O. Box null

Street Address 2

Street Address 2 Apartment/Suite/Unit/Building/Floor

City

City null

State

State null

Zip Code

Zip Code 5 digit zip code null

Email Address

Email Address null

Does the benefiting organization offer health (medical) insurance to its employees?

Does the benefiting organization offer health (medical) insurance to its employees? null

Health Insurance Carrier

Health Insurance Carrier

About the Benefiting Program

About the Benefiting Program

Program Name

Program Name null

Brief Program Description

Brief Program Description (max 250 characters) null

What county or counties does this program serve?

What county or counties does this program serve? null

What metrics or outcomes will be used to measure success?

What metrics or outcomes will be used to measure success? (max 250 characters) null

How much funding are you requesting per year (if known)?

How much funding are you requesting per year (if known)? null
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