FY 2026 EMS Trauma-Related Equipment Grant

FY 2026 EMS TRAUMA-RELATED EQUIPMENT GRANT
GRANT OVERVIEW
Purpose: Provide eligible 911-zone providers funding to purchase trauma-related equipment to enhance prehospital trauma care in Georgia.

Awards: Funding varies by eligible 911-zone provider (ATTACHMENT A). Grant funds may not be used to supplant, reduce, or reallocate existing local budget allocations for 911-zoned EMS response systems.

Scope: Grant funds can be used to purchase eligible equipment approved by the GTC EMS Committee (ATTACHMENT B). If an equipment item is not listed on the approved list, agencies may submit a special equipment request form for EMS consideration by November 5, 2025.

Application: Click "Continue to Application" below to start your grant application. Applications will be accepted starting October 15, 2025. The deadline to apply will be December 15, 2025
APPLICATION INSTRUCTIONS AND PROCESS
1. Applications must be completed via Jotform, including an attachment of a notarized affidavit no later than December 15, 2025. Applications will not be accepted after this deadline.
- Application sections include:
  - Applying organization information & contacts
  - Agency's current peak ambulance count
  - List of eligible equipment that has been or will be purchased and placed into service (item, quantiy, price, and total)
  - Certification & signature by individual authorized to submit application
  - Upload completed and notorized affidavit (ATTACHMENT C)
2. After submission, the Georgia Trauma Commission staff will evaluate all timely submitted applications.

3. Applicants will receive a notification of receipt, approval, and payment updates.

4. Please allow up to 60 days to receive grant funds after application submission.
ELIGIBILITY REQUIREMENTS
The applying organization must:

1. Be a 911-zone provider in the county for which grant funds are requested

2. Be contracted to remain in the county through June 30, 2026.

3. Participate in the respective EMS region system plan.

4. Attend 50% of Regional Trauma Advisory Committee (RTAC) in-person and/or virtual quarterly meetings.

5. Maintain compliance with the Department of Public Health State Office of EMS data submission requirements.

FY 2026 EMS TRAUMA-RELATED EQUIPMENT GRANT APPLICATION

Open October 15, 2025 - December 15, 2025
Please complete this application in its entirety and submit it via JotForm by the deadline. The Georgia Trauma Commission will not accept applications received after December 15, 2025
SECTION 1 | ORGANIZATION INFORMATION
Applying 911-Zone Provider Legal Organization Name*
Doing Business As “DBA” (if differs from Legal Name):
EMS Region # *
1-10
County* for which funds are being requested*
*A separate application is required for each county
Federal Tax ID Number*
GA EMS Provider License Number:*
Mailing Address (Address, City, State, Zip Code)*
Address must be an approved organization address with the State of Georgia Accounting Office
Is your mailing address the same as your payment address?

YesNo
Payment Address* (if differs from mailing address)
Address must be an approved organization address with the State of Georgia Accounting Office
Agency Director Contact Information:
Name*
Title*
Email*
example@example.com
Phone*
Are you applying as the Agency Director listed above, or as another individual authorized to apply on behalf of the agency?

Agency DirectorIndividual Authorized to Apply on Behalf of Agency
Individual Authorized to Apply on Behalf of the Agency

(authorized agency agent (if different from Agency Director):
Name
Title
Email
example@example.com
Phone
Would you like to add an additional contact if questions arise regarding this application?

YesNo
Contact for Further Information on the Application

(if different from above)
Name
Title
Email
example@example.com
Phone
RTAC Meeting Attendance Liaison

The applying agency must specify an internal agency representative (liaison) to attend these meetings. (see Grant Terms #5 on Affidavit; must attend 50% of RTAC meetings)
Name*
Title*
Email*
example@example.com

SECTION 2: AMBULANCE COUNTS
As of October 15, 2025, what is the “peak demand staffed” 911 response ambulances for this 911 zone?*
Please note "peak demand staffed" does not infer total ambulances. The peak number of ambulances are thte total number of scheduled and staffed on a consistent basis. The number reported in this application will be used for next year's grant. The reported peak number is subject to further inquiry.

SECTION 3: DESCRIPTION OF EQUIPMENT
Please complete the table below to detail the eligible equipment that has been or will be purchased and placed into service. Refer to ATTACHMENT B for the list of approved equipment. The amount you are eligible to apply for is outlined in ATTACHMENT A. If the total cost listed below exceeds the approved amount, you will only be reimbursed up to the agency’s allocation. If the total is less than the approved amount, you will be reimbursed based on the amount requested.

Please list your items with complete details below. Please insert "n/a" where applicable.

	Equipment Item	Equipment Category	Peds or Adult Equipment	Item Unit Price ($)	Item Quantity (#)	Total ($)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

Grand Total Cost of All Items Purchased/Purchasing (can include freight/shipping)*

BEFORE YOU SUBMIT YOUR APPLICATION
Please ensure to attach the completed and notarized affidavit (ATTACHMENT C)*

Must be completed with a visible notary stamp
Cancelof
SECTION 4: CERTIFICATION AND SIGNATURE BY AUTHORIZED AGENCY AGENT
I certify the information contained in the submitted application is true and accurate to the best of my knowledge and that I have submitted this application and notarized affidavit (ATTACHMENT C) affirming all nine (9) conditions on behalf of the Applying Organization.
Signature (use computer mouse cursor)*

Clear
Printed Name and Title*
Date*

MonthDayYear
Date
EMS TRAUMA-RELATED EQUIPMENT GRANT APPLICATION CHECKLIST

Reviewed eligibility requirements on page 1Reviewed eligible grant funds (ATTACHMENT A)Reviewed the approved equipment list (ATTACHMENT B)If trauma-related equipment is not listed on approved equipment lists, submitted a special request form before November 5, 2025Completed the list of equipment eligible for reimbursement on page 4Completed the grant application in its entirety and signed the application on page 5Completed and attached notarized affidavit on page 5 (ATTACHMENT C)
Should be Empty:

FY 2026 EMS TRAUMA-RELATED EQUIPMENT GRANT

GRANT OVERVIEW

APPLICATION INSTRUCTIONS AND PROCESS

ELIGIBILITY REQUIREMENTS

FY 2026 EMS TRAUMA-RELATED EQUIPMENT GRANT APPLICATION

SECTION 1 | ORGANIZATION INFORMATION

Agency Director Contact Information:

Individual Authorized to Apply on Behalf of the Agency

Contact for Further Information on the Application

RTAC Meeting Attendance Liaison

SECTION 2: AMBULANCE COUNTS

SECTION 3: DESCRIPTION OF EQUIPMENT

BEFORE YOU SUBMIT YOUR APPLICATION

SECTION 4: CERTIFICATION AND SIGNATURE BY AUTHORIZED AGENCY AGENT