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555 Fitness Grant Application
The 5-5-5 Firefighter Fitness is a 501(c)3 Non-Profit organization
Email address *
In order for your application to be eligible, you will need the following in Picture, PDF, or Document format. *
Required
Application progress can NOT be saved. Please preview the application below before you begin in order prepare your responses. https://goo.gl/BGY037
Responses may be edited after application is submitted.
Have you previously applied for our grant? *
Name Of Organization *
Submission Date *
MM
/
DD
/
YYYY
City *
State *
Two Letter Code
Organization Contact Person *
Contact Persons Email *
Job Title/Function *
Phone Number *
Numbers Only
Person(s) Submitting Grant Application *
Department Type *
*Note: Representative from both sides of a combination department (career and volunteer) may submit their own application. If submitting only ONE APPLICATION, we ask you provide individual responses for your side of the organization. Also, please submit both representatives contact info on page one under “Persons Submitting Grant Application”
Annual Operating Budget *
Number of Department Stations *
Number of Career Members *
Number of Volunteer Members *
Do you have an active explorer post?
Total Number of Members *
Number of Responses for 2016 *
Number of Responses for 2017 *
Size of First Due Response Area
Approximate Population Served *
Number of Engines/Pumper
Number of Trucks/Ladders
Number of Rescues
Number of Ambulances
Total Number of Department Vehicles
Which branch of Emergency Services does your department represent?
List all department social media account handles/usernames (Facebook, Instagram, etc).
Currently, do any of your stations have a fitness facility? *
What equipment is used most frequently? *
What equipment would you like to see added? *
Closest Gym *
Include Name and Distance
2nd Closest Gym *
Include Name and Distance
Do any local gyms offer discounts to members? *
Will all members/affiliates of your organization have full use of the equipment at all times (i.e. volunteer/career, fire/EMS)? *
Do you have a current SOP/SOG regarding health and wellness? *
If so, please upload a PDF or Word Doc copy at the end of this form.
Is there a minimum fitness requirement for your organization to become a member and to retain current status within the organization? *
If so, please upload a PDF or Word Doc copy at the end of this form
Do you have any members that compete in fitness events? *
Bodybuilding, Scott Challenge, Stairclimbs, Crossfit WODS
Are any members Certified Fitness Trainers?
Please list their names and certifications/credentials
500 Word or Less: Your plan to implement a physical fitness program in your department. *
Please be as specific as possible
500 Words or Less: How do you/your members/your department plan on helping 555 Fitness? *
Please be as specific as possible
What distinguishes your department's needs from all the other applicants that submitted for this grant?
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