EmailMe Form - 2023 FCCM Grant Application

2023 FCCM Grant Application

2023 Free and Charitable Clinic's Month (FCCM) Grant Application. This August, the Association is spearheading Illinois’ 9th annual FCCM because we want everyone to know the vital role you play in strengthening the healthcare safety net. The goal of the month is to celebrate and support the accomplishments and contributions of free and charitable clinics.
All IAFCC Members are eligible to apply for a mini-grant from IAFCC to support the costs for events, supplies, etc...

If you are interested in applying for a mini-grant please complete the application below by June 30, 2023

Clinic Name *
Contact Name *
First Last
Email *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
What will the grant be used for? *
Amount Requested
$ Dollars . Cents
Email
If awarded, IAFCC would like to share information about your event.
Do we at IAFCC have permission to share information about your event publicly
Yes
No
If yes please share your website and/or Facebook link
Facebook link
If awarded a grant IAFCC is asking for a brief report in order for us to share this event externally. To demonstrate our accomplishments this month we are asking all clinics to report to IAFCC by 9.15.23. These questions do not need to be filled out now however by accepting this mini grant you agree to answer the following questions:

1. Number of attendees
2. Number who received patient care
3.How this grant assisted the clinic in improved access to care
4. How this grant promoted heath and wellness in their community
5. This grant clinics addressed a health disparity. Examples include (list name of clinic and disparity addressed for the specific population)
6. Any other information about how your clinic used the mini grant in August
7. Information about outreach for your event
8. # of articles published about your event
9. # of people reached through social media
10. Quotes from patients, volunteers, administrators about your event. *