UPMC Central PA 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 need(s) you plan to address:

Department/Organization Name

Program Name:

Program Manager

Contact Information

Funding Period

Total Funding Request

Project Description

Describe your program and strategic initiative you seek to address: (Support for Vulnerable Communities; Health & Life-Long Wellness; Workforce Development)

Please list goals for this project

List a minimum of 3 goals.

Please list measurable outcomes for this project

List a minimum of 3 outcomes.

Project Narrative

Please answer the following questions regarding the intent of your project. How will this project/service increase equitable access to health care? How will this project/service address health disparities and social determinants of health for specific populations? What measures will you take to sustain this project at the completion of Foundation funding?