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Call for Applications:

Community-led Learning Event Support

Eligible Wisconsin-based learning event host organizations are invited to submit the following application to apply for AHW’s Call for Applications: Community-led Learning Event Support.

The application form must be completed and submitted using this online form and no paper or emailed applications will be considered. The online application form only supports Plain Text. No text effects such as bold, italics, underlining, bulleting, numbering, etc. will be captured in the form fields in the final submission.

Refer to the Request for Applications (RFA) accessible via the Funding Opportunities section of the AHW website for additional instructions and requirements.

Applications are accepted on a rolling basis, and will be reviewed on a first come, first serve basis, until available funds have been distributed.

Please note that all fields marked with * are required.

AHW does not discriminate against individuals on the basis of age, race, creed, religion, color, disability, marital status, sex, national origin, ancestry, sexual orientation, gender identity, arrest record, conviction record, membership in the national guard, state defense force or any other reserve component of the military forces of the United States or the State of Wisconsin or use or nonuse of lawful products off MCW’s premises during nonworking hours.

Learning Event Information

Learning Event Title:

Goal Statement - Please provide a brief statement describing the goal of the proposed learning event, including the learning or professional development gap or need that the event aims to address, and the intended health workforce audience that will participate in the event. (maximum 400 characters, including spaces)

Event Start Date:

Event End Date:

For one day events, end date should equal start date.

Where do you anticipate hosting the event? (maximum 500 characters, including spaces)

Budget Request

Total Amount Requested:

(in whole dollars and

not to exceed $5,000 maximum)

Additional Funds:

(if applicable)

Source of Additional Funds:

(if applicable)

Project Team Information

Learning Event Host Organization Contact


Contact Name:	First	Middle	Last	Suffix/Credentials

Preferred Name:

For example, enter 'John' if that is your preference rather than Johnathan.

Pronouns:

Title:

Work Phone Number:

Cell Phone Number:

Email:

Authorized Signature Name (if different from contact):

Authorized Signature Email:

Learning Event Host Non-Supplanting Attestation

Attach completed Non-Supplanting Attestation (PDF) here. Please download the template from the Funding Opportunities section of the AHW website.

Collaborators

Collaborators – Please list additional organizations or individuals that are co-hosting the event or supporting event planning and implementation. Collaborators are not subject to learning event host organization eligibility requirements. Please note that the online form is limited to ten collaborators.

Name:	Organization/Department:

Narrative

Event Description – Describe of the goal of the learning event, the learning or professional development need the event aims to address, and how the event content (including speakers, materials, etc.) will help meet the learning goal. (maximum 2,000 characters, including spaces)

Event Participation – Describe the primary audience that will attend the learning event, the anticipated number of participants, and how the event is informed or supported by the target audience, co-hosts, or collaborators. (maximum 2,000 characters, including spaces)

Evaluation and Post-Event Action – Describe how the learning event will support participants to apply their learnings to their work, and how the event hosts will evaluate participant learning and event objectives. (maximum 2,000 characters, including spaces)

Budget and Budget Justification

Attach completed Budget Workbook (Excel) here. Please download the template from the Funding Opportunities section of the AHW website.

Attach completed Budget Justification (PDF) here. Please download the template from the Funding Opportunities section of the AHW website.

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Contact Information

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LinkedIn Handle:	Instagram Handle:

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