Jonathan A Erickson Fund Grant Application This application form is for grant funding from the Jonathan A Erickson fund for programs or projects that raise awareness of mental health illnesses or expand care for mental health. Please complete this application and include all required documents to be considered for funding. Organization/Agency Name and Tax ID #* Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Email Address* Phone*Amount Funding Requested*Include the amount of funding you are requesting from GRHF for your project. (Enter an amount in the form 0,000.00)Additional Funding and Amounts*The Gogebic Range Health Foundation does not fund 100% of projects or programs. Please list any additional funding sources and amounts that will contribute to your total project budget. Organizational Summary*Describe your organization's mission and purpose. Also, explain how your organization is prepared to administer and implement your proposed project. Project Summary and Proposed Goals*Please describe your proposed project and overall goals. Please include in your description; what the impact will be on mental health care or how it will raise awareness of mental health illness, and any other community health concerns your project will address.Project Activities and Outcomes*Please describe the specific activities of the project and the outcomes of the activities that will lead to your overall stated goals. Also, describe who is responsible for each activity and how it will impact community mental health care. Collaborations and Partnerships*Please describe any collaborations or partnerships that you have with other organizations to carry out this project. Also, describe each organizations role in the project. Primary Audience and Location ServedDescribe the audience or population which your project will impact. Also, discuss any health concern, specific to your audience that your project will address. Project Sustainability and Management*Please describe your plan to ensure sustainability and longevity of this project/program in the future.Budget Form*The budget form will be emailed to you in word format. Please use the budget form to create your budget. Save the document as a PDF and upload here. Drop files here or Select files Max. file size: 50 MB. Letters of Support*Please include 2 letters of support from different organizations. Drop files here or Select files Max. file size: 50 MB. Authorization of Proposal*Please include a letter from your board of directors or organization leadership authorizing your application for funding. Max. file size: 50 MB.Other supporting documentationPlease include any additional supporting documents. Drop files here or Select files Max. file size: 50 MB. CAPTCHA
