State or county alliance:

Project contact person:

Contact e-mail address:

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Project description:
To receive an AMA Alliance grant, you must address the two stated goals. Please briefly describe how you will achieve these goals in your community. These goals should correspond with the activity timeline below.

Budget:

Activity timeline

Activity 1

Audience/Target

Timeline

Corresponds with goal
1
2

Activity 2

Audience/Target

Timeline

Corresponds with goal
1
2

Activity 3

Optional field if your program includes additional activities

Audience/Target

Timeline

Corresponds with goal
1
2

Activity 4

Optional field if your program includes additional activities

Audience/Target

Timeline

Corresponds with goal
1
2

Activity 5

Optional field if your program includes additional activities

Audience/Target

Timeline

Corresponds with goal
1
2