Administrative Support Partnerships
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12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character
Organization/Initiative Name
Primary Contact
First Name
Last Name
Email
Phone
Website (if applicable)
Geographic Focus (City/State or Region)
In 3-4 sentences, describe your initiative and its primary activities.
What is your mission and how does your work contribute to improving health or the well-being of communities?
Do you have a 501(c)3?
Yes
No
Other
If other, please explain.
What stage is your initiative in?
Idea
Early implementation
Established program
Other
If other, please explain.
Do you currently have confirmed funding?
Yes
No
Other
If other, please explain.
What is your confirmed funding amount(s) and funding source(s)?
Do you have a designated staff person (can be employee, volunteer, or contractor)? Briefly describe how will the work be staffed and managed day to day (e.g., team size, roles, or key responsibilities).
Do you have a governing body (e.g., board of directors, steering committee, or advisory committee?
Yes
No
Other
If other, please explain.
What support are you seeking from a fiscal sponsor or grant/contract administrator? (Select all that apply).
If unsure, select the areas where you anticipate needing support.
Financial management
Grant, Contract, and Subaward management
HR
Fundraising support
Program design or operational support
Program management
Other
If other, please explain.
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