Healthiest Manitowoc County | Money Request for Coalitions

First and last name *

Phone Number *

Email Address *

What coalition do you belong to? *

What level of partnership are you? *

Member of Coalition

Steering or Executive Committee Member

Co-Chair of Coalition

OtherOther

Which health indicator do you plan on addressing? *

Increase the % of children ready for kindergarten

Increase % of organizations and policies trained or changed to be trauma informed sensitive

Increase graduation rates from high school

Increase % of youth meeting or exceeding recommended physical activity levels per week

Decrease % of adult obesity rates

Increase % of businesses includeing worksite wellness initiatives

Increase % of individuals accessing health services

Decrease substance use rates (tobacco, alcohol, perscription drugs)

Decrease suicide rates

How much money are you requesting? Please provide a minimum amount needed to carry out activity and a maximum amount if you were able to complete everything in your vision. *

How do you plan on using the money? *

Administrative Needs (meeting supplies, copies, etc.)

Programing (activity, campaign, etc.)

For administrative needs, please briefly describe what will be purchased. For programing needs, please provide details about the activity, timeline, how this will help achieve your health indicator, and what the money will be used for. *