Automated External Defibrillator (AED) Grant Program
Online Application Form
Applicant's Information
Name
*
First Name
Last Name
Facility Name
*
Position
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Facility's Information
Number of Employees
*
Number of Volunteers
*
Number of Daily Public Users
*
Number of Facility Accessible Hours per Day
*
Please briefly describe the types of activities that take place in your facility that make you a sport and recreation facility.
Looking at the EHS AED Registry Map (nsgi.novascotia.ca/EHS-NS-Volunteer-AED-Map/), where are the two nearest AEDs to you?
*
Required Documents
Do you have proof of purchase?
Please Select
Yes (Please send to rfans@sportnovascotia.ca)
No (Required)
Do you have an outline of staff training?
Please Select
Yes (Please send to rfans@sportnovascotia.ca)
No (Required)
Is this your first time applying?
*
Please Select
Yes
No
Other
If other, please specify
How did you hear about the AED Grant Program?
*
Are you a MEMBER of RFANS:
*
Please Select
Member
Non-Member
Would you like to become a MEMBER of RFANS:
*
Please Select
Please contact me
Do not contact me
Date
*
-
Month
-
Day
Year
Date
Signature
*
Clear
Save
Submit
Should be Empty: