Community Partners Grant Funding Request Form

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The UPMC Pinnacle Foundation is pleased to review your request for funding. Funding requests received by the 15^th of the month will be considered at the Board meeting scheduled for the following month. Please complete the following information so we can better understand the community need you plan to address:

Project Name:

Organization:

Contact Name:

Contact Phone Number and Email:

Total Funds Requested:

Impact Guidelines (Please select the guideline(s) that you plan to address) 1. Social Determinants of Health 2. Health and Wellness 3. Workforce Development

Target Population (Please describe the target population for this project)

Project Description (Please provide a detailed description of your proposed project, including how you will partner with UPMC to improve access to care, address social determinants of health, and reduce health disparities for the communities we serve.)

Project Goals (Please provide 1-3 goals for this project)

Required Budget Spreadsheet

Please attach the required budget spreadsheet. Available to download from our UPMC Pinnacle Foundation Funding webpage.