Giving

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Organization

Organization Name*
Organization Address*
Organization City*
Organization State*
Organization ZIP*
Organization Phone*
Organization Website
Letter of Determination
Please upload your Letter of Determination (PDF or DOC format, 2MB max), or fax a copy to 520-299-4609 (Applications without the Letter of Determination will not be eligible for funding.)
If you are faxing the Letter of Determination, please indicate that here.
I will fax it.

Contact Person

Name*
Address*
City*
State*
ZIP*
Phone*
Email*

Project Information

Desired Month*
Would you like your application to be considered for another month if you are not chosen for the one you select?
Yes
Project Overview*

Please provide an overview of the project for which you are requesting a Trustee Award.
Summarize in one sentence the specific purpose/goal for which you are requesting a Trustee Award.*
Please state the need for this project.*
How is your project different than what currently exists?
How does your project work to improve public health?
Describe the target demographics of the population your project will directly serve.*
What specific outcomes do you expect to achieve?*
How will outcomes be evaluated?*
Please list the total cost of the project, including other sources and levels of funding.*
Project Start Date (MM/YY)*
Project End Date (MM/YY)*
Provide any additional information you want us to know about the timing of your project.*
How will the grant be used for this project?*
How will the Tucson Osteopathic Medical Foundation be recognized for funding this project?*
Does this project involve any lobbying?*
Yes
No
Please provide any supporting data.