Letter of Inquiry Submission Form

Thank you for your interest in working with the Blue Cross & Blue Shield of Mississippi Foundation. The first step in applying for a Blue Cross & Blue Shield of Mississippi Foundation grant is to submit a brief Letter of Inquiry. Please use the form below to make your submission. Once your Letter of Inquiry has been reviewed, you will receive one of the following:

  • A request for more information
  • A request for a full grant application
  • A letter informing you that the Foundation has elected not to fund your project


Your Contact Information: Please complete all items.
*1) First name: *7) Your mailing address:




*2) Last name: 8) Your apt or suite (if required for delivery):


*3) Your email: *9) Your city:


*4) Your phone: *10) Your state:


I am legal resident of the State of Mississippi.
*5) Organization/Group Name: *11) Your zip code:


*6) Project Name:  
 
   
*12) Briefly describe the issue the project seeks to address:


*13) Into which of the Foundation's Areas of Interest does your project fit?
Children's Health and Wellness
Community Health Initiatives
Promotion of Healthy Lifestyles and Choices

*14) How do you define success for the program, and how will you measure it?


*15) Provide information about key personnel who will lead the project, and about their qualifications:


*16) Provide an estimate of the project's total budget:


*17) Indicate the amount of financial support you seek from the Blue Cross & Blue Shield of Mississippi Foundation:


*18) Explain how funding from the Foundation will help achieve the goals of the project:


*19) Explain how the project could be easily replicated to serve as a model for other communities in the state: *


* Required Fields

  






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