Automated External Defibrillator (AED) Grant Program
Online Application Form
Applicant's Information
Name
*
First Name
Last Name
Facility Name
*
Position
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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 upload below)
No (Required)
Do you have an outline of staff training?
*
Please Select
Yes (Please upload below)
No (Required)
File Upload
Browse Files
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Is this your first time applying?
*
Please Select
Yes
No
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
Yes
No
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
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