2020 NIRH Request for Proposals:
Proactive Local-level Policies and Initiatives

Submitting a Proposal

Please fill out the below coversheet and upload your proposal by November 12, 2019 at 8 p.m. EST. If multiple organizations are submitting a proposal together, each should complete a separate coversheet.

Should you have any questions or concerns about using this form, please contact Winnie Ye at wye@nirhealth.org for assistance.

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* 1. Proposal Title

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* 2. Project Category

Responding Proactively to State or Federal Attacks on Abortion

Advancing a Proactive Policy Included in the Local Index's Model City

Training Local Officials & Advocates to Support a Proactive Local Policy Initiative

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* 3. Funding Amount Requested

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* 4. Legal Name of Organization
If your proposal is selected, this is the name the check will be made out to.

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* 5. Public-facing Name of Organization (if different)

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* 6. Projected 2020 Organizational Budget

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* 7. Projected 2020 Project Budget, if applicable
Please include if the amount exceeds funding requested from NIRH.

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* 8. Employer Identification Number (EIN)

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* 9. Mailing Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

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* 10. Street Address (if different)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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* 11. Primary Contact for Management of Initiative
This should be the person who will be working most closely with NIRH on the project, if funded.

Full name

Title

Phone Number

Email address

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* 12. Primary Contact for Management of Funding and Reporting (if different)
This should be the person who will be managing the financial process with NIRH, if funded.

Full name

Title

Phone Number

Email address

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* 13. Project Summary
Please provide 2-3 sentences summarizing your project. Feel free to pull from your executive summary in your proposal.

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* 14. Are you partnering with an organization or multiple organizations on this initiative?
If yes, please list the names of the organizations in the box below. Only one organization needs to upload a copy of the proposal.

Yes

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* 15. Please upload your proposal.

Include the name of your organization and your proposal title in the header of your proposal and please save the file name with the following template: Organization Name_NIRHLocalProposal_Date.

If you are submitting a proposal with multiple organizations, only one organizations needs to upload the proposal and all organizations must submit a coversheet.

If you prefer to email your proposal, please email it to Winnie Ye at wye@nirhealth.org.

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Question Title

* 1. Proposal Title

Question Title

* 2. Project Category

Question Title

* 3. Funding Amount Requested

Question Title

* 4. Legal Name of OrganizationIf your proposal is selected, this is the name the check will be made out to.

Question Title

* 5. Public-facing Name of Organization (if different)

Question Title

* 6. Projected 2020 Organizational Budget

Question Title

* 7. Projected 2020 Project Budget, if applicablePlease include if the amount exceeds funding requested from NIRH.

Question Title

* 8. Employer Identification Number (EIN)

Question Title

* 9. Mailing Address

Question Title

* 10. Street Address (if different)

Question Title

* 11. Primary Contact for Management of InitiativeThis should be the person who will be working most closely with NIRH on the project, if funded.

Question Title

* 12. Primary Contact for Management of Funding and Reporting (if different)This should be the person who will be managing the financial process with NIRH, if funded.

Question Title

* 13. Project SummaryPlease provide 2-3 sentences summarizing your project. Feel free to pull from your executive summary in your proposal.

Question Title

* 14. Are you partnering with an organization or multiple organizations on this initiative?If yes, please list the names of the organizations in the box below. Only one organization needs to upload a copy of the proposal.

Question Title

* 4. Legal Name of Organization
If your proposal is selected, this is the name the check will be made out to.

* 7. Projected 2020 Project Budget, if applicable
Please include if the amount exceeds funding requested from NIRH.

* 11. Primary Contact for Management of Initiative
This should be the person who will be working most closely with NIRH on the project, if funded.

* 12. Primary Contact for Management of Funding and Reporting (if different)
This should be the person who will be managing the financial process with NIRH, if funded.

* 13. Project Summary
Please provide 2-3 sentences summarizing your project. Feel free to pull from your executive summary in your proposal.

* 14. Are you partnering with an organization or multiple organizations on this initiative?
If yes, please list the names of the organizations in the box below. Only one organization needs to upload a copy of the proposal.