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Health Promotion Policy Grant Application

Applications must be received at least two weeks prior to the event for which funding is being requested. Alliances are limited to one award per calendar year. Depending on the project, grant awards generally range from $100 to $500. For assistance in completing this application, refer to the HPPG guidelines.

HPPGs are intended to support county and state Alliance health promotion projects. Please complete the entire application.

*Asterisk indicates required field.

*Alliance name:

*Project coordinator:
(This person will receive check.)

*Street:

*City:

*State:

*Zip:

*Phone number:

*E-mail address:

Your e-mail address will not be shared, sold, traded, exchanged or rented.
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Title of project:

Date of project:

* List specific project goals and describe how the project is structured to meet those goals:

Cite specific AMA Alliancepolicy that supports this event: (Refer to AMA Alliance Policy.)

How many people will be participating in/benefiting from this event or project? Please be specific and break out Alliancevolunteers/coordinators, activity participants, and others that might be affected by the program.

How will this activity increase the visibility of the AMA Allianceand your Alliance?

How and to whom will you be publicizing the event/project before it takes place?

What are the anticipated costs for this activity and how were they determined? Provide as much budget detail as possible and list all funding sources/collaborators, if applicable.

What plans are in place to follow up with this activity in the future? How will the AMA Alliancecontinue to be involved in promoting the topic or issue that was addressed by this activity?

How will you determine the success of this activity?

Last updated: May 13, 2008
Content provided by: AMA Alliance