Jonathan A Erickson Fund Letter Of Intent Form

Complete this application proposal form and include all required documents for your project to be considered for funding. Incomplete applications will not be reviewed.
Organization/Agency Name and Tax ID #*
Name*
First Last
Organization Address*
Street Address City State / Province / Region ZIP / Postal Code
Email Address*
Phone*
Amount of Funding Requested*
Projects will be funded between $5,000 and $25,000. Amendments to your request may be suggested.
Project start date*
Month
Day
Year
Expected project end date*
Month
Day
Year
Proposal Summary*
Provide a brief summary of the purpose of your project, the expected impact on the health of the community and how it aligns with the Gogebic Range Health Foundation's mission and the Jonathan A Erickson Fund.
Proposed Activities*
Briefly describe the efforts or activities of the project that will lead to the stated impact on community health.
Primary Audience and Location Served*
Where will your program or project take place and whom is the targeted audience that it will serve?
Additional Funding Sources*
The Gogebic Range Health Foundation will not serve as a primary funder. Please list your other funding sources.
Letter of Support*
Please provide a letter of support from your organization's director, governing board or overseeing authority.
Max. file size: 50 MB.
Supporting Documents
Supporting documents could include, program reports from other similar programs, articles validating your program or projects or data that shows impact of your program.
Drop files here or

Max. file size: 50 MB.
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