The AWB Foundation Funding Application
Please fill out each of the following questions. Provide as much detail as possible regarding your financial need and why it is critical to your project. 

Thank you for all you do to make the world a more compassionate place!

In the spirit of service,

Christine Cronin
Executive Director
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Email *
Full name as it is on your professional license and/or Federal/State issued identification *
Phone number *
Mailing address *
Physical address (if it is different than your mailing address). If your mailing address and physical address are the same, please state N/A below. *
What is your organization status (e.g., 501(c)(3), Corporation, etc.) *
Have you taken an AWB training before? Either Healing Community Trauma or Repairing the Shattered Heart Certificate Program. If other, please tell us which course. *
For Medical Professionals: Which state(s) are you licensed to practice in? Please provide your license number(s). 

If you are someone who has volunteers who are medical professionals but you are not one yourself, please state what professional licenses your volunteers hold.
 *
Describe what medical professionals make up your team and their roles. *
Do you have general liability insurance? *
Do you have malpractice insurance? If not, do those who volunteer for you have malpractice insurance? *
Have you organized or done field work before (ie. disaster response or mobile clinic?) *
Please describe your project with the following information: Which population does it serve? How many people do you serve currently? What service does it provide? Where is your project located? Why is the work important to the population you serve? *
How are you in need of financial assistance? How would these funds support you in getting your project off the ground or allow it to expand to the next level? *
Thank you for filling out this form. We will get back to you within 4 weeks of your submission date.
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