Health New England's DEIB Grant Submission Form
Due Midnight on Wednesday, July 31, 2024
Lead Organization
Organization Name
*
Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
Point of Contact Full Name
*
First Name
Last Name
Point of Contact Title
*
Point of Contact Email
*
example@example.com
Point of Contact Phone Number
*
Please enter a valid phone number.
Program Name
*
Program Date(s)
*
Dollar Amount Being Requested
*
Up to $10,000
Describe the program you are planning to implement, enhance or expand, who will be served, what you are intending to achieve, and how it addresses youth health and well-being.
*
Adolescent well-being framework .
*
Good health and optimum nutrient
Connectedness, positive values, and contribution
Safety and a supportive environment
Learning, competence, education, skills, and employability
Agency and resilience
Describe how health equity is embedded into your program. This may include inequities related to race, language, social, economic, and/or environmental systemic barriers to accessing culturally sensitive health care and health resources.
*
Social Determinants of Health (SDOH) focus
*
Built Environment - access to healthy food, transportation, access to parks/open space
Education - higher education, language and literacy, early childhood education and development
Employment - economic stability, poverty,
Housing - physical conditions within homes, housing affordability, homeless
Social environment - social isolation, interpersonal and structural racism
Violence and trauma
Estimate Reach / Anticipated Number of Lives Program will Touch
*
Describe how you will evaluate the success of the program or initiative. Include a description of what success will look like.
*
At least one goal.
Geographic Area Served (choose all that apply)
*
Berkshire
Franklin
Hampden
Hampshire
Worcester
Are you currently a Health New England employer group?
*
Yes
No
Submit
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