UPMC Central PA Grant Funding Request Form

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The UPMC Pinnacle Foundation is pleased to review your request for funding. The UPMC Pinnacle Foundation Board approves funding requests at their meetings scheduled in January, March, May, July, September, and November. All applicants will be contacted by Foundation staff following the Board meeting. Applications must be submitted by the 15^th of the prior month for funding consideration.

Project Name:

Contact Name and Department:

Contact Email:

Amount Requested:

Direct Supervisor Name:

Impact Guidelines (Please select the guideline(s) that you plan to address) 1. Social Determinants of Health 2. Health and Wellness 3. Workforce Development

Target Population (Please describe the target population for this project)

Project Description (Please provide a detailed description of your proposed project, including how this will impact the ability to provide high quality care for our patients.)

Project Goals (Please provide 1-3 goals for this project)

Required Budget Spreadsheet

Please attach the required budget spreadsheet. Available to download from our UPMC Pinnacle Foundation Funding webpage.