UPMC Pinnacle Foundation Funding Request

Applicant Information:

Organization/Department:

Contact Person:

Contact Email:

Contact Phone Number:

Mission Statement:

Total Amount Requested:

Project Details:

Need Statement: Why is this project necessary? What problem does it address?

Project Description: Provide a detailed description of the project, including how you will improve access to care, address social determinants of health, and reduce health disparities for our patients.

Target Population: Please tell us about the patient population who will be served if this funding request is approved.

Financial Information

Budget Narrative: Provide a detailed breakdown of the total funds requested. Include specific details for each expense.

Evaluation

Evaluation Plan: Describe how you will evaluate the effectiveness of the initiative.

Additional Information

Partnerships: What other organizations are involved in this project? Describe their roles.

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