HAFP Foundation Project Grant Application – Hawaii Academy of Family Physicians

Project Grant Application

HAFP Foundation Project Grant Application

Date *

Name *

Email *

AAFP Member # *

Log into your AAFP profile if you do not know your AAFP Member # (https://www.aafp.org/home.html)

Medical School/Residency Program/Practice Name *

Class Standing (i.e., MS1, OMS1, PGY1 if applicable)

Address (check will be mailed to this address) *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Project Title *

Project Description *

Describe the purpose of your project, your target audience, goals for your project, and how your project will improve primary care in Hawaii.

Project Start Date: *

Project End Date *

Amount Requested (maximum of $1,500 available) *

Other Funding Sources (if applicable)

Please provide details of other funding sources (if applicable) for this event, such as program funding, other grants, etc.

If awarded, I give HAFP Foundation permission to use my photo and event report in HAFP member materials, such as newsletters, website, etc. *

Project Budget *

Drag & Drop Files, Choose Files to Upload

Upload a general budget for your project, including costs supplies, travel, etc.

Upload photo

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Upload CV/Resume

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