Blue Cross & Blue Shield of Mississippi Foundation

Thank you for your interest in working with the Blue Cross & Blue Shield of Mississippi Foundation. The Foundation provides targeted grants for health and wellness initiatives that typically span a one-year period of time. The initiatives funded by the Foundation have a focus on healthy eating and exercise, with measurable outcomes demonstrating improvement in the health of Mississippians.

The first step in applying for a grant is to submit a brief Letter of Inquiry. Please type directly into the Letter of Inquiry form below to make your submission. It is important to not copy text from another document and paste it into this form because that can cause errors when you submit your inquiry, including preventing some text from submitting.

When you have completed your Letter of Inquiry and click the "Submit My Inquiry" button you will receive a screen message (not an email) thanking you for submitting a Letter of Inquiry and for your interest in working with the Blue Cross & Blue Shield of Mississippi Foundation. 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

* Required Fields

Contact Information for Individual Submitting Letter of Inquiry:

*1) Salutation (Dr., Mr., Ms., etc.):

*2) First Name:

*3) Last Name:

*4) Your email:

*5) Your phone:

*6) Relationship to Requesting Organization:

Information Regarding Requesting Organization:

*7) Organization Name (legal name):

*8) Organization Type 501(c)(3) Municipality University or College K-12 School

9) If 501(c)(3), Organization's Tax ID number:

10) Website URL of requesting organization:

*11) Does the organization have a nicotine-free (i.e., tobacco-free, cigarette-free and vape-free) environment on all organization-owned property? Yes No

If no, does the organization have plans to implement a nicotine-free (i.e., tobacco-free, cigarette-free and vape-free) environment on all organization-owned property? Yes When? No

*12) Salutation of Executive Representative: (Dr., Mr., Ms., etc.):

*13) First Name of Executive Representative:

*14) Last Name of Executive Representative:

*15) Email of Executive Representative:

*16) Phone of Executive Representative:

*17) Organization Address (line 1):

18) Organization Address (line 2):

*19) Organization City:

*20) Organization ZIP Code:

*21) Organization County

Information Regarding Proposed Initiative:

*22) Name of proposed initiative:

*23) Briefly describe the proposed initiative and how it will impact the overall health of Mississippians, specifically in the areas of healthy eating and exercise:

*24) Number of individuals your organization will impact by the proposed initiative:

*25) List three goals the proposed initiative seeks to address:

*26) Provide an estimate of the project's total budget (Numbers Only):

*27) Indicate the amount of financial support you seek from the Blue Cross & Blue Shield of Mississippi Foundation (Numbers Only):

*28) Summarize how Foundation funds will help achieve the goals of the proposed initiative:

*29) Provide details of other funders approached and details of any funding already received for the proposed initiative:

*30) If funded by the Foundation, explain how the proposed initiative can become sustainable: