Columbia Gorge Health Council/PacificSource SDOH/E Funding
Below is a list of the questions in the narrative portion of the application. Feel free to cut and paste these questions to a separate document for writing and editing. This is not the application. The application itself does not allow you to save and return to it. It must be loaded and submitted in a single session.
Person submitting name:
Tax Identification Number (EIN #):
Total Amount requested:
Total Project Cost:
1. Organization mission and primary activities:
2. Which 2020-2023 CHIP Priority(ies) does this project address (select all that apply):
___ Improved access to equitable health care services
___ Dental ___ Primary ___ Behavioral ___ Health Insurance ___Prevention/Promotion
___ Improved access to equitable physical activity and the outdoors
___ Improved Social Connection and Communication
___ Sense of Community ___Collaboration and Information Sharing
___ Youth and Children
___ Youth Safety ___ Early Childhood Development and Child Care
3. Please provide more explanation about the Priority(ies)/gaps you selected above.
4. How will your proposed work address the Priority(ies)? (What are your goals?)
5. How have the Priority(ies) selected or your proposed work been impacted by the Covid pandemic?
6. Who and how many people will this project serve? (include an estimate of how many served (#)
and percentage (%) of total number served who are Oregon Health Plan members living in Wasco
or Hood River counties)
7. What impact will this project have on the people served?
8. How will you use these funds to support your proposed work? (What will funds be spent on?)
9. If this is a collaborative project, please identify the partner agencies and their roles in the project.