APPLICATION: 2024 Put Us on the Map Challenge
Thank you for your interest in applying for the 2024 Put Us on the Map Challenge to join the City Health Dashboard! In this application, we are inviting you to share your proposal for why we should add your small city to the Dashboard. Cities with populations between 1,000 and 50,000 will be selected and added to the Dashboard in summer 2024. For complete information about the Challenge, eligibility, and timeline, read more here: https://www.cityhealthdashboard.com/blog-media/put-us-on-the-map-2024-application.

Please review the entire form before beginning your application. You will NOT be able to save your application or return to edit after you have submitted. Multiple applications for the same city will not improve your chances of being selected. All applications are due by 5pm ET on Friday, March 1st.

If you have additional questions, please email caleigh.paster@nyulangone.org.
اپنی پیشرفت محفوظ کرنے کے لیے Google میں سائن ان کریں۔ مزید جانیں
Full Name (First and Last) *
Email *
Name of City Requested *
Can be a city, town, village, borough, township with a population size between 1,000 and 50,000.
State *
Name of Organization or City Department *
Organization or City Department Website
Job Title *
City Population Estimate (between 1000 to 50000) *
Why would local data on health and its drivers make a difference for your city? *
How do you envision using the site and data? *
Describe any active partnerships that support your ability to accomplish your data-driven goals. If applicable, please list any names or organizations that would be involved in this process with you. *
If you are applying as an individual or organization outside of local government, please consider including a Letter of Support from a partner within government. A template can be found at this link. 

If you choose to include a Letter of Support, please email to caleigh.paster@nyulangone.org.
I agree to providing feedback and learnings from the data for the purposes of a blog or Impact Story, to be shared on the City Health Dashboard website. *
Put Us on the Map Challenge 2024
Review and Submit
Please be sure you have completed the application to the best of your ability (including emailing a Letter of Support if needed). You will not be able to return to edit your application after submitting. If you'd like to save your responses, you can print your response now before submitting.

Thanks again for applying. Good luck!
جمع کرائیں۔
فارم صاف کریں
کبھی بھی Google Forms کی معرفت پاس ورڈز جمع نہ کرائیں۔
یہ فارم City Health Dashboard کے اندر ہی تخلیق کیا گیا تھا۔ بیجا استعمال کی اطلاع دیں
Forms Google