Cal Wellness Letter of Interest
Letter of Interest Instructions
Cal Wellness is moving to a new and improved grants management system. In early 2019, we will have a new online Letter of Interest form. In the interim, you are invited to apply using this form.
Please note, you can not save this form and come back to work on it. The form needs to be submitted or the information will be lost. If you select the "Send Me My Responses" checkbox and enter your email address at the end of this form, you will receive an email confirmation with a copy of this request once you click the "Submit" button.
Within three months from the date of submission, we will contact you to request a full proposal or to notify you that your request has been denied.
If your organization or project is under an umbrella organization (sometimes called a fiscal sponsor), please enter information only for your organization or project on this application, except where otherwise indicated.
If you have any questions, please email email@example.com or call (818) 702-1900 and ask for Grants Management.
Name of the organization conducting the work.
Please enter the Employer Identification Number for your organization, or if your organization/project falls under the umbrella of a larger tax-exempt organization (sometimes referred to as a fiscal sponsor), then use that organization's EIN.
State (ex. CA)
Phone (ex. 510-555-1234)
Contact for this request. This contact will receive all correspondence related to this request.
Contact Phone (ex. 510-555-1234)
This amount should be for the entire length of the requested grant period.
Duration of Requested Grant Period
(in whole months, maximum of 36 months)
Select one grantmaking program area that best reflects your request from the drop-down menu. Descriptions are available on the Cal Wellness website.
Advancing Health Care Reform and the Affordable Care Act
Improving Oral Health Care for Low-Income Adults and Seniors
Increasing Diversity in the Health Professions
Strengthening Community Clinics and Safety-Net Partners
Increasing Educational Opportunities for Resilient Youth
Promoting Employment and Asset-Building Opportunities
Advancing Public Policy
Strengthening the Nonprofit and Philanthropic Sector
Fostering Healthy Environments
Promoting Violence Prevention
Identify whether this grant request is for core operating support or for project support.
Core operating support helps underwrite the day-to-day administrative, infrastructure and overhead costs that enable an organization to carry out its mission. Core operating support from Cal Wellness may also be used to sustain a specific, ongoing program within an organization, or to maintain existing health services.
Project support refers to the development of a new, or expansion of a specific, program or efforts to address the social determinants of health and improve the health of Californians. Two examples of project support are development of a new health education program, and staff salaries for a new project or program.
Core Operating Support
Geographic Area(s) of Focus
Name all of the geographic area(s) that are applicable to the grant request (e.g. cities, counties or regions).
Please note that Cal Wellness supports efforts within California that improve the health of Californians. If the area is statewide or nationwide, please state that.
Brief Summary of Request
Provide a one-sentence description of your request. Please limit the sentence to 25 words. You will have an opportunity to explain your request in greater detail in the Request Narrative.
Request Narrative Attachments
Please upload a narrative that describes the following:
(1) The issue(s) the organization or project will address; what geographic area(s) and population(s) will be served or targeted and why.
(2) How Cal Wellness funds will be utilized to address the identified issue(s) listed above (please include specific strategies, approaches and activities).
(3) How the proposed work aligns with our grantmaking program, Advancing Wellness.
(4) Two key accomplishments of the organization.
Please limit the request narrative to no more than two pages, using a 12-point font and one-inch margins. Please use the majority of the two pages to answer items 3 and 4 above. Accepted file types are Microsoft Word (.doc or .docx) and Adobe PDF (.pdf).
Send me a copy of my responses
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