Rx Kids - Request Funding Summary
Interested in learning more about the cost of launching Rx Kids in your community? Community leaders may use this form to request information on costs to implement Rx Kids in a given Michigan community. 

If the form is not complete, or is for a community that is already launched/is launching soon, please be aware that you likely will not receive a response

By completing this form, you will receive the following estimates for your community:
  • Number of births 
  • Medicaid birth rate 
  • How much state funds could be available if selected
  • How many additional funds would need to be raised to launch Rx Kids
An Rx Kids staff member will respond to your inquiry within 5-7 business days

Please email Rx-Kids@msu.edu if you have any questions.

NOTE: This is NOT the application to be a participant in Rx Kids or an interest form for residents. If you are a participant in an active Rx Kids community, you can apply here.  If you are a resident of a community wanting to advocate to bring Rx Kids to your community, consider writing a message of support. 
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Email *
Name (First and Last) *
Organization Name

NOTE: If you are a resident looking to advocate to bring Rx Kids to your community, and NOT part of an organization that can serve as the community champion/an organization looking to raise funds, please consider writing a message of support for bringing Rx Kids to your community
 *
Organization type *
What jurisdiction are requesting for? This must be a specific, geographically bound area (defined as Townships, Cities, Counties, or Zip Codes)

Requests for non-specific funding estimates, such as "southwest Michigan" will not receive a response. 

Note that zip codes and townships/cities are often overlapping
 *
Did you attend an Rx Kids webinar? *
Have you otherwise been in contact with the Rx Kids team before? *
If you have been in contact with Rx Kids team before, please describe
If other people from your community request a funding summary, do you consent to Rx Kids sharing your contact info with them? *
Do you plan to share this information? If so, with who?
Anything else you want us to know?
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