DTA Foundation Grant Application

Is this a pilot project, new research, or new model or approach*

YesNo
I'm sorry, only new innovative pilot projects are eligible for funding this year.

See below for a very small list of other grantmaking organizations out there and thank you for all that you do for oral heatlh!

Will the funding be primarily used for equipment purchases or existing services or salaries?*

YesNo
I'm sorry, because this is seed funding, we cannot provide monies for equipment purchases or ongoing / exising services or salaries.

See below for a very small list of other grantmaking organizations out there and thank you for all that you do for oral heatlh!

2. Contact Information
Primary Contact*

First NameLast Name
Contact Title*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Project Manager's Information (Only complete if different from primary contact)
Project Manager's Full Name

First NameLast Name
Title
Phone Number

Area CodePhone Number
E-mail
To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form from the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

5. Implementation & Post Award Plans
Please describe project implementation including phases with dates for total project time period. Simply listing is completely fine.*

0/300
Describe plans for evaluating the program and measuring success*

0/200
How do you plan to share the project outcomes or research or results (do you plan to present at conferences or meetings, publish the results, work with anticipated partners, share via online or other outlets, etc)?*
Please address here anything else about your organization or project you think is relevant to this proposal. Feel free to leave this blank.

0/200
Please upload a projected project budget (guesswork is fine at this point). *

Browse Files

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To Save Your Application
If at any time you'd like to leave this form and save it in progress, please click on the next button and exit your browser. To resume your submission at a later time, return to the form from the link contained in your registration email. (YOUR BROWSER MUST BE ENABLED TO ACCEPT COOKIES. DATA IS SAVED LOCALLY IN YOUR BROWSER UNITL SUBMITTED)

Technical Assistance
Should you have technical questions regarding the online submission process, please contact us at (614) 246-8904.

6. Grant Submission
*

I certify that I am authorized by the the Executive Director and / or Board of Directors to submit this proposal on behalf of the organization.
*

I do hereby acknowledge that all information contained in this application and accompanying documents are accurate.
*

I agree that the insertion of data into the following fields constitutes an electronic signature.
Name *
Title*
Date*

DTA Foundation Pilot Project Grants