Resilient Health Network, Inc. - Fair Share Microgrant Application

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Resilient Health Network, Inc. supports individuals and organizations who promote human and environmental health. This microgrant fund is intended to ensure that valuable health-related education and services are valued fairly while ensuring that they remain accessible and that money should never be a barrier to participation. Although multiple applications are accepted, the current grant limit is $500 per applicant per year. Funds can only be applied to the proportion of the services that are educational in nature (e.g., tuition for a class might be 100% educational in nature, whereas a massage might only be 10% educational in nature).

Email *

Name *

Date of Birth *

YYYY

Phone Number *

Race / Ethnicity (optional)

African American or Black

American Indian or Alaska Native

Asian (Chinese, Filipino, Japanese, Vietnamese, Korean, Asian Indian, etc.)

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Other:

Clear selection

Mailing Address *

City *

State *

Zip Code *

Organization Name

FEIN

Funding Category *

Earth Care - Environmental Health

People Care - Human Health

Other:

Required

Which kinds of expenses are you applying to have reimbursed

Education Tuition (Health & Wellness Education / Events)

Education Tuition (Permaculture / Regenerative Agriculture Education)

Education Tuition (Other Environmental / Ecological Education)

Service Fees (Acupuncture)

Service Fees (Chiropractic)

Service Fees (Herbal Consultation)

Service Fees (Massage)

Service Fees (Medical [Functional / Integrative])

Service Fees (Midwifery / Doula / Birth)

Service Fees (Yoga)

Educational Materials (For Health-Related Courses & Events)

Lodging (For Health-Related Courses & Events)

Venue Rental (For Health-Related Courses & Events)

Other:

Amount Requested ($1 - $500) * *

Funding Request Details - describe how the funds will promote resilient health *

Payment Method *

Check (mailed to individual / organization at address provided)

PayPal (transferred to PayPal account associated with email address provided)

Other:

Describe Your Financial Need *

Based on my 2020 IRS tax filings, I attest that my income was: (https://aspe.hhs.gov › 2020-poverty-guidelines) *

Below 100% of the Federal Poverty Level

Between 100% and 400% of the Federal Poverty Level

Greater than 400% of the Federal Poverty Level

Prefer not to answer

Send me a copy of my responses.

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