Blue Earth County SHIP Application

Blue Earth County SHIP Application
Thank you for your interest in creating better health for our community in Blue Earth County!

Please submit the following information if your organization is interested in partnering with SHIP to request local SHIP funding.

Blue Earth County SHIP staff are available to answer questions on this application process.

Project approval will be based on review of submitted project applications, County and Minnesota Department of Health guidelines, and available local SHIP funds. Project funding is not guaranteed.
- Please note this is not a complete list.
- - Building or paving a walking or bike path, or cement (except for cement for bench or basketball hoop installation)
  - Cash assistance paid directly to individuals to meet their personal or family needs
  - Clothing
  - Donations or raffles
  - Designated smoking area signs
  - Entrance fees to parks or recreational facilities for individuals or small groups
  - Equipment repair or maintenance costs or replacement of functioning equipment
  - Land rental for gardens
  - Memberships to clubs, camps, fitness centers and similar groups or scholarships
  - Ongoing rental fees for equipment use at a recreational center or park
  - Stand-alone meals or ongoing subsidies of healthier food alternatives in vending machines, school lunches or workplaces
  - Start-up of a non-profit or private business venture
- Organization*
- Name*
  
  First NameLast Name
- Title or Role Within the Organization
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- Active Living in the CommunityCommercial Tobacco Free in the CommunityFood Access in the CommunityHealthcareSchoolsWorkplaceChildcare
- In 3-5 sentences, describe your project idea and intended outcomes. *
- In 4-5 sentences, describe how this project idea supports a policy, system, or environmental change to improve health and wellbeing within your organization and our community.*
- Please list any additional partners who are working with you on this project.
- In 3-5 sentences, describe how you plan to evaluate this project for success.*
- In 3-5 sentences, describe how this project will be maintained beyond initial SHIP funding.*
- Under $1,000$1,000-$2,999$3,000-$4,999$5,000-$10,000Unknown
- Submission
  
  If you have entered all of the required information of this form, the "Submit" will be shown below. Information submitted on this form will be sent via email.
  
  To receive a copy of your submission, please check the box below and provide an email address for the submission to be sent.
  
  For additional assistance in completing this form, please call 507-304-4411.
- I would like to receive a copy of my submission
- Email to which you'd like your submission to be sent
  example@example.com
Should be Empty:

Blue Earth County SHIP Application

Please note this is not a complete list.