Social Mission Grant Proposal

At Blue Cross Blue Shield of Michigan, we're committed to a healthier Michigan. One of the ways we promote good health in Michigan is by providing grant funding.

If your organization would like to apply for a grant, please fill out the form below.

Section One: Who's applying

Your organization

Organization Name

Address

City

State

* Please note only Michigan organizations can apply for a grant.

ZIP Code

Contact information

President or Executive Director Name

Organization Contact Name (if different than above)

Title

Phone

Section Two: About your organization

1. Describe your organization's mission statement.

2. Tell us about the communities your organization serves.

3. Please provide a brief description of your organization.

Section Three: About your grant proposal

Which of these categories best describes your proposal?

Access to care. For programs and initiatives that focus on improving access to health care. Health status. For programs and initiatives that improve the health of Michigan residents through childhood obesity prevention, healthy eating and physical activity.

Please answer these questions about the project you want to fund.

1. Tell us about the project. Be sure to include goals and measurable objectives as well as your implementation plan and timeline.

2. What community needs will this grant help you address?

3. What amount of funding are you requesting? Will your organization or a partnering organization be contributing matching funds?

4. Tell us about the history of your organization, including a summary of similar projects and their outcomes. Be sure to include past grants from Blue Cross Blue Shield of Michigan.

5. Tell us about the projects manager's qualifications, experience and relevant relationships.

6. What challenges do you see with this project? How will you overcome them?

7. How do you plan to keep us updated on the project?

8. Do you have any partners on this project? If so, describe their roles.

9. What other resources will you need during this project?

10. Show us a detailed budget for the proposed project.

By submitting this form, I swear that my answers are true to the best of my knowledge. I understand that if any of these answers are false, my organization could be disqualified from being considered for a grant.