HeartStrong Community Health Grant Application

HeartStrong Community Health Grant 6 Business Application

Thank you for your interest in the HeartStrong Community Health Grant, sponsored by Johnnie Doris Capital Holdings LLC. This application is intended for healthcare organizations in Northwest Georgia seeking funding to support initiatives that improve patient outcomes, expand access to care, and strengthen community health. Please complete all sections thoroughly. Incomplete applications may not be considered.
Organization Name
Practice/Facility Name (if different)
Organization Type
Primary Contact Name
Title/Role
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Organization Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Zip Code
Brief Description of Your Organization
What population do you primarily serve?
What is your organization's mission statement?
How does your proposed initiative align with your mission?
We are a licensed healthcare organization serving Northwest Georgia
We are requesting funding for a healthcare-related initiative
We have a clear plan for how funds will be used
We can identify a target patient population
We have a method to track outcomes or impact
Project Title
Type of Initiative
Describe your proposed initiative
What problem are you trying to solve?
Estimated Number of Patients Impacted
What outcomes do you expect?
How will you measure success?
Grant funds must be used for direct patient care improvement initiatives that produce measurable outcomes. Please clearly outline how the requested funds will be allocated and how they will directly benefit patients.
How will funds be used?
Select all applicable uses
Funds will NOT be used for general operating expenses
Funds will NOT be used for unrelated business costs
Funds will be used strictly for healthcare improvement
If selected, how will your organization communicate and promote being a recipient of this grant?
Select all that apply
Upload Proposal or Supporting Plan and Proof of Organization (Optional)
Company Email
example@example.com
Company Website
Company Type
Company Size
Years in Operation
Should be Empty:

HeartStrong Community Health Grant 6 Business Application