Health Equity Mini Grant Application

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

County or Counties

Project Lead Name

Phone

Email *

an Performance institution

Applicant is a 501c3

Yes
No

Applicant is an academic institution

Yes
No

Applicant is a member of WVRHA

Yes
No

Amount of funding requested:

Funds are not being used to match another grant opportunity

Yes
No

Project: (50 Points)

Provide a summary of the proposed project to include a description of the project goal or goals. (Indicate how this project will impact rural health or health equity.)

Activities: (25 Points)

Provide a detailed description of the activities proposed to meet the goal or goals. Provide a description of the location / setting for the project. (Projects must take place in West Virginia with a priority given to those in rural counties)

Performance Objective: (10 Points)

Develop at least one measurable performance objective. The measurable performance objective should correspond with the activities proposed and state the desired outcome of the intervention. Applicants should provide performance measures for all activities proposed.

Timeline: (5 Points)

Provide a project timeline. (Include a start date remembering all projects must be completed by December 31, 2026.)

Budget: (10 Points)

Provide a detailed description of how the funds will be used. Any unexpended funds must be returned at the end of the project period. Indirect costs are not allowable.

Health Equity Mini Grant Application

Our mission is to unite people, communities and organizations to strengthen rural health in West Virginia.

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