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Eform
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
Benefiting Organization
Federal Tax Identification Number
Contact Name
Phone Number
Street Address 1
Street Address 2
City
State
Zip Code
Email Address
Does the benefiting organization offer health (medical) insurance to its employees?
Health Insurance Carrier
Program Name
Brief Program Description
What county or counties does this program serve?
What metrics or outcomes will be used to measure success?
How much funding are you requesting per year (if known)?