My Impact

August 2020

Grant Application

First Name*
Last Name*
Email*
Tribal Affiliation*
Age*
Mailing Address

City

State

Zip Code

Phone

Name of Your Adult Mentor*

Adult Mentor Title/Position

Adult Mentor Address

Adult Mentor City

Adult Mentor State

Adult Mentor Zip Code

Adult Mentor Phone

What do you plan to do?*

Who will take part?*

Who will benefit from your service project?*

How will you promote your event?*

What is your budget for the project? How much to you need? How will you spend it?*

TO SUPPORT YOUR COMMUNITY SERVICE PROJECT, WE R NATIVE WILL:

Help you and your team brainstorm a project that you feel excited about!
Provide your adult mentor with up to $475. You can use the funds for just about anything: Food, participant incentives, t-shirts, contest prizes, travel expenses, and print materials - whatever you need to make your event a success.
Promote your project on the We R Native website, Facebook page, and text messaging service.

IN EXCHANGE FOR THE MINI-GRANT, DO YOU AGREE TO:

Provide a completed Adult Mentor signiture form
Fill out the an evaluation form after the event takes place. And document the community service project using photographs, videos, or digital storytelling.
Submit all completed forms, photographs, and/or videos to native@npaihb.org within two weeks of the event.
Videos should be no more than 4 minutes long. Post them on YouTube and then send us the link. If other people are shown in your photos or videos, please make sure you have their permission to show their image in this way.

THE DETAILS:

By submitting an entry, you grant the Northwest Portland Area Indian Health Board (NPAIHB) the right to use, edit, and disseminate submissions in print, online, and through other forms of media for educational, public service, or health awareness purposes. By submitting an entry, you release the NPAIHB and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

Yes, I Agree*

Yes, I Agree

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Phone

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