Oregon Health Authority HIV/STD/TB (OHA HST) Program Sponsorship Application
Prior to starting this application, please read carefully the sponsorship application requirements on our website.
Contact Person Information
Name of the Organization
Organization mission statement
What is the primary geographic region your organization serves?
Which communities are your organization’s priority populations?
Are you or your fiscal sponsor a 501(c)3?
Organization tax ID number
If you answered yes, please list your organization tax ID number
Have you received a sponsorship from the OHA HIV/STD Prevention Program in the past?
If yes, what date did you receive sponsorship and what amount did you receive?
How does this project differ from the project funded before?
Proposed Sponsorship Project
Which category best describes the main goal of your project?
HIV treatment & adherence support
Reducing stigma and promoting health equity
Please answer the following questions about the project you are proposing. You will be asked to upload several documents at the end of the application, including answers to questions 1-5, resumes/CVs for project key staff (optional), and a budget. Please limit your answers to Questions 1-5 to no more than 3 pages total.
1. In a few sentences, please describe the main goal of your project.
2. Please describe the main things you plan to do with these funds that will lead to achieving your project goal.
3. Please describe your timeline for completing the work (NOTE: funds must be spent within one year of award).
4. Please describe who will benefit from this project (for example, the number of people served or affected, the proposed demographics of people served or affected, etc.).
5. Please identify the key staff who will be doing the work on this project, including their names, work experience, and job titles. You may submit resumes or other descriptive information (resumes/CVs will not be counted in the page total).
Please submit a brief budget for this project using the attached template provided. We request a total amount (up to $10,000) and a brief description of how the money will be used (line items). There are some restrictions on the use of these funds, so even if your project is approved for funding, budgets may need to be negotiated before allocation of funds. Some examples of expenses that are not allowable include food and beverages, equipment, and furniture.
Please upload the following
1. Responses to Questions 1-5 (required)
2. Your budget document (required)
3. Key staff resumes/CVs (optional)
Send me a copy of my responses
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