BMH Foundation for Community Health
Grant Application Form
Please complete and upload all information requested below.  If you have any questions about this application, please contact Victor Farmer at 304-369-1230 xt 5522 or

Organization Information

Organization Type * 🛈

Contact Information

Project and Organization Background

Project Financial and Timeline Information

Are any other entities funding this project? * 🛈
Are any other entities providing in-kind resources for this project? * 🛈


Project Impact and Need Information

The BMH Foundation for Community Health supports and funds projects and programs which are designed to improve population health by addressing the social determinants of health. As recognized by the CDC, the social determinants of health include: 
  • Healthcare Access and Quality: the connection between people's access to and understanding of health services and their own health. This includes access to health care, health insurance coverage and health literacy.
  • Education Access and Quality: the connection of education to health and wellbeing. This includes graduating from high school, enrollment in higher education, educational attainment, language and literacy, and early childhood education.
  • Social and Community Context: the connection between characteristics of the contexts within which people live, learn, work, and play, and their health and wellbeing. This includes cohesion within a community, civic participation, discrimination, conditions in the workplace, and incarceration.
  • Economic Stability: the connection between the financial resources people have (income, cost of living, and socioeconomic status) and their health. This includes issues such as poverty, employment, food security, and housing stability.
  • Neighborhood and Built Environment: the connection between where a person lives (housing, neighborhood, and environment) and their health and wellbeing. This includes quality of housing, access to transportation, availability of healthy foods, air and water quality, and neighborhood crime and violence
More information on the social determinants of health can be accessed at this link
Please provide as much detail as possible in this section.
Which social determinants of health does your project address? (select all that apply) *

Project Sustainability

Application Signature

By electronically signing this application, I hereby certify that all information provided is true and accurate to the best of my knowledge, and that I am authorized to submit this application on behalf of the organization listed. I acknowledge and understand that Boone Memorial Foundation for Healthy Living may deny my organization's request or grant my organization's request in whole or in part. I also understand that if my organization's request is granted, Boone Memorial Foundation for Healthy Living may impose certain conditions on the funding, which may include spending restrictions, reporting requirements, or other conditions. *