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Home > About > Community Relations & Outreach > Community Health Grant Program > Community Health Grant Application

Community Health Grant Application

The application form for a Community Health Grant from UVA Health System.

Note: This form cannot be saved for later completion. Applicants must complete and submit the form in a single step for the application to be considered.

Policies & Requirements Acknowledgment

Non-Discrimination

University of Virginia Health System has an unwavering commitment to equal access and opportunity for all. Organizations applying for funding should be prepared to demonstrate that they do not discriminate on the basis of race, color, religious creed, national origin, age, sex, marital status, sexual orientation, gender identity, handicap, disability, medical condition or veteran status, either in their employment or their service policies and practices.

Conflict of Interest

University of Virginia Health System asks each organization requesting a contribution to disclose any relationships with University of Virginia that may be, or appear to be, a conflict of interest. Such relationships do not necessarily prohibit your organization from receiving a contribution; however, they must be disclosed in order for University of Virginia Health System to complete its due diligence.

Requirements for Grants and Reports

A contract will be issued to successful applicants. It will include information on various contingencies or pre-funding requirements. The agreement emphasizes our expectations for superior performance. Mid-year progress and final reports are required for all investments. 

Organization Information

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Organization Type:  


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Did your organization participate in the MAPP2Health community health assessment and health improvement planning process?  


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Program Information

From the list below, please select which MAPP2Health priority area(s) your program aligns.   Programs that do not have strong alignment with MAPP2Health priorities will not be eligible for funding.

Document Upload

Required:

  • A copy of the tax-exempt status determination letter from the Department of the Treasury Internal Revenue Service
  • A list of the organization’s board of directors (or the governing body) and their affiliations
  • List of other funding sources to which this proposal has been submitted
  • The organization’s current annual operating budget and most recent audited financial statement (or IRS Form 990 if an audit is not performed)

Not required: Up to three (3) relevant letters of support

Attaching Files

You can either upload one document containing all required files or upload files as separate attachments below.

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