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HAP Award Entry Form

American Medical Association Alliance, Inc.
Health Awareness Promotion (HAP) Awards Entry Form

Entries will be judged only on the written project summary. The summary should contain the following: description of goals, impact on community or target audience, impact on the Alliance, and budget and donation summary.

Tip: This screen may not allow you to print your entire application. In order to have a copy of the application may we suggest typing it out as a Word document first and then cutting and pasting the information into the appropriate sections of the online form.

Project Information: All fields must be filled out to submit form.

Name of Project

New project

Project on-going from previous year
If ongoing, please list Project Bank #

HAP Award Category (Check only one category)

Community Service/Health Education

Fund-raising

SAVE

Alliance Information:

Number of county or RPS/MSS Alliance members

Number of state Alliance members

Number of national Alliance members in your county

Number of Alliance members who actively participated on project

Alliance volunteer hours on project

Official County Alliance name

County President name

President's phone number

Contact name

Contact Alliance position

Address

City

State

Zip code

Phone

Fax

E-mail address

Your e-mail address will not be shared, sold, traded, exchanged or rented. See our Privacy Policy for more information.

Project Description: All fields must be filled out to submit form.

Judges will refer only to your project description when reviewing your entry. Please do not refer to the name of your Alliance in the project description.

Project Summary
Provide an overview of your project, your target audience, highlights of the project, your budget, funds, donations and whether or not any co-sponsors were involved. Limit 350 words.

Description of Goals
Briefly outline the project’s goals, what planning was involved, and who was responsible for the implementation of the goals. Limit 350 words.

Impact of Project on Community or Target Audience
Describe and evaluate ways in which your project met its goals and highlight all areas of success. Limit 350 words.

Last updated: Nov 09, 2007
Content provided by: AMA Alliance