The Community Pharmacy Foundation

Grant Application - The Community Pharmacy Foundation

NOTE: This grant application should only be used as a reference. All grant applications should be submitted online at: http://communitypharmacyfoundation.org/mycpf. Only online grant applications will be reviewed for acceptance.

Grant Application Details

1.	Amount requested
2.	For what time period (months)
3.	Grant program/project title
4.	Brief description of the objectives for this program/project (5 - 7 sentences):

5.	Will it be financially self-sustaining	Yes No N/A
6.	Were other funding sources provided	Yes No N/A

If "YES," what were the other funding sources and the approximate funds provided by each

7.	Will your organization provide matching funds	Yes No
8.	Does this program/project involve collaboration with another health profession or health professional organization	Yes No
9.	Have you had your work published in a peer reviewed publication	Yes No

10.	List the top 4 anticipated expenditures as a percentage of total budget (i.e. salaries – X%, marketing – X%, data analysis – X%, postage and supplies – X%). Please note CPF does not cover indirect costs.
11.	Other comments regarding the grant application or submission process (2-3 sentences).

12.	Do you have the capability to create a 3-5 minute video submission describing your final project/study results?	Yes No Unsure
13.	Will your program/project involve pharmacy student participation?	Yes No Unsure

Organization Details

Applicant Registration Information
	First Name
	Last Name
	Email Address
	Organization
	Position/Title
	Prof. Credentials

What is your organization's contact information?
	Organization's Mailing Address:
	City
	State/Province
	Zipcode
	Phone (Main)
	Web Site	http://

Type of organization:

For Profit Entity

Non Profit