Home
Welcome
Contact Us
Award Programs
Grant Requests
TCC Blog
Changing the definition of healthcare delivery in America.
Grant Requests
Please complete the enclosed application for grant consideration. Follow application carefully. Incomplete or inaccurate forms not accepted.
Organization Name
*
Please include requesting organization's legal name.
Contact (First Name)
*
Contact (Last Name)
*
Contact Phone Number
*
(###) ###-####
Organization Phone Number
*
(###) ###-####
Contact's Email Address
*
[contact]@[website].[org or com]
Organization's Website Address
http://www.[address].[org or com]
Organization's Mission
*
Organization's Physical Address
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Title of Requested Grant
*
Years of Operation
*
1 - 4 years
5 - 9 years
10+ years
Amount Requested
*
Please use numbers only.
Designation (Check all that apply)
*
Non-profit (501c3 or other)
Minority Owned Enterprise
Disability Owned Enterprise
Women Owned Enterprise
Veteran Owned Enterprise
Other
Target Audience (Check all that apply)
*
Adults with Disabilities
Children with Disabilities
Children / Youth
Dads
Grandfamilies
Grandparents
Low-income Families
Men
Moms
Moms-to-be
Seniors
Seniors with Disabilities
Women
Young Adults
Other
Culture/Ethnicity (Check all that apply)
*
African American
Asian (Chinese, Korean, etc.)
Caucasian
Disability Community
Native Hawaiian / Pacific Islander
Hispanic
Native American (Native Alaskan, etc.)
Other
Please choose applicable topic (select only one):
*
Aging in Place
Asthma
Autism
Behavioral Health / Mental Health
Caregiver Mental Health Support
Community Improvement
Cultural Competency
Eating Disorders
Education
Financial Assistance
Foster Care Support
Free Cell Phone
Free/Reduced Health Care: Dental
Healthy Food Access
Health & Wellness Program
Homeless / Housing Services
Obesity (Adults or Children)
Pregnancy-related Support
Smoke Free Environments
Substance Use (inc. Opioid)
Transportation
Utility Assistance
Veteran's Services
Workforce Innovation
Other
If other, please describe
If Health & Wellness Program, please indicate if the program is evidence-based, evidence-informed or other
*
Evidence-based
Evidence-informed
Other
Not Applicable
Description of Grant
*
Please provide 3-5 sentences to describe your micro-grant and the anticipated impact of the micro-grant to your organization and/or to the community
Objective #1
*
Objective #2 (if applicable)
*
(Please include "N/A" if not applicable.)
Objective #3 (if applicable)
*
(Please include "N/A" if not applicable.)
Verification
Please enter any two digits
*
Example: 12
This box is for spam protection -
please leave it blank
:
Be Committed to Your Community!
Be Active
Be Informed
Be Vocal
Other Items of Interest
Latest Launch Event
Statement of Commitment