2024 Breast Reconstruction - Public Awareness Grant Application

2024 Breast Reconstruction - Public Awareness

Grant Application
Public Awareness Application
Organization's Name:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Main Contact:*

First NameLast Name
Organization's City, State:*
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Total Amount Requested: (Not to exceed $10,000)*
Do you have an ASPS member(s) involved in your project? If so please provide name(s) and ASPS ID.*
What percentage of your organization's current activities are specifically focused on educating or promoting breast reconstruction?*
How many years has your organization participated with Breast Reconstruction Awareness (BRA) Day?*
Is your organization a Breast Reconstruction Awareness (BRA) Day "Affiliate"? (https://www.thepsf.org/programs/breast-reconstruction-awareness-campaign/get-involved)*

YesNo
Have you received a PSF Breast Reconstruction Awareness Fund Grant in the past? (Select all that apply)*

Yes - Charitable Care GrantYes - Public Awareness GrantNoOther
Please provide a description of your organization, specifically highlighting your past experience and commitment to raising breast reconstruction surgery awareness.*
Provide a detailed description of your proposed program or event. Include activity details, intended audience, resources, etc.*
Please describe what educational resources will be used to inform women on Breast Reconstruction for this program. Include the source and content (if applicable) of the educational material and the extent, type and way in which information will be disseminated.*
Have you successfully implemented a similar program/activity in the past? Please Describe:*
How will you quantitatively measure the success and effectiveness of this program?*
In what ways will the funds requested be used to promote breast reconstruction awareness? (Select all that apply)*

Social MediaEblastsOnline AdvertisingWebsite ImprovementsWebinarsPrinted BrochuresMagazine AdvertisingNewspaper AdvertisingSignage: Banners, Flyers, Posters, etcBooksRadioTelevisionVideosOther
How many people do you expect to be exposed to breast reconstruction information because of this award through media, mailing, e-blast, etc (do not including in-person education)?*
How many people do you expect to be educated about breast reconstruction in-person because of this award?*
Does your proposal include an event or gathering to educate women on Breast Reconstruction?*

YesNo
What best describes the type of event(s) you propose to hold? (Select all that apply)

BRA Day EventBreast Cancer Awareness EventFundraising EventDinnerAuctionRun/WalkExpert Panel DiscussionConferenceInformal GatheringOther
What percentage of your event will be focused solely on Breast Reconstruction?
What is the overall expected attendance of those exclusively being educated on Breast Reconstruction?
Does this proposed program target a community/population that has not been reached through existing initiatives; or use new or innovative approaches to reaching its target population? *
Does the program include any implementation strategies, including fundraising efforts, that will help sustain the activities after the completion of the funding period?*
If profits/sales will be generated from your program, will a percentage of the proceeds go back to breast reconstruction awareness in some way?*

YesNoN/AOther
If you answered "Yes" to the above question, please provide more details:
PROGRAM BUDGET: Provide a detailed budget for the amount requested. If the budget exceeds the amount requested, then provide information on how the additional funding will be or has been acquired. The requested funding should ONLY be for Breast Reconstruction related expenses and not to be combined with general Breast Health or Cancer Awareness expenses. If only a portion of your event/program is Breast Reconstruction related, the budget should reflect the appropriate percentage.

Important: Please review the link below for allowable and non-allowable expenses:

https://www.thepsf.org/documents/Programs/Grants/BRAfund-Public-Awareness_Allowable-Expenses.pdf

IMPORTANT: Please upload all attachments as PDFs and label clearly to indicate the required document you are submitting, including the name of your organization. EXAMPLE: "Proposed Program Budget_(name of organization)"
Upload Proposed Program Budget Here:*

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List the names and ASPS ID's for each Plastic Surgeon who will be involved in the implementation of the project.*
Provide a description of the anticipated benefit that this award will have on your organization, breast reconstruction patients and your community.*
How will you recognize The PSF within your grant program? If past awardee, how have you recognized The PSF in your promotional materials, website, etc.?*
Upload a current list of Board of Directors here.*

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Do you have an IRS Section 501(c)(3) Exemption Letter*

YesNoOther
Upload your Exemption Letter here.

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Do you have your most recent IRS Form 990?*

YesNoOther
Upload your 990 Form here.

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Upload your organization's current annual budget here.*

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Please use the following uploads for any additional information, pictures, examples, etc. you wish to provide.

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2024 Breast Reconstruction - Public Awareness

Public Awareness Application