Book Grant Application - Charlie's Kids

Organization Name(Required)

Tax ID Number, if applicable

Name(Required)

Prefix First Last

Phone Number(Required)

Email Address(Required)

Organization Website(Required)

Type of Organization (select all that apply)(Required)

Hospital/birthing center

Non-profit

Public/government health department

Doctor's office

Safe Sleep Advocacy Program

Other

Please describe how your organization currently promotes safe sleep.(Required)

Briefly describe your target population for safe sleep education.(Required)

Please describe how a donation of Sleep Baby Safe and Snug books will help you achieve your goals and promote safe sleep.(Required)

Please describe the nature of your organization's request and how you plan to use Sleep Baby Safe and Snug.(Required)

Will the books be used for a one-time campaign or long-term effort? If long-term, please indicate the timeline for the campaign.(Required)

Please describe how your organization normally obtains funding for your safe sleep efforts.(Required)

Please include whether or not you receive funding from other safe sleep partners.(Required)

Have you previously used Sleep Baby Safe and Snug in your safe sleep education efforts?(Required)

Yes

If yes, how was SBSS use funded?

How will your safe sleep campaign be affected if you are not chosen for our donation program?(Required)

(Limit 16 cases total, 60 books/case)

Number of Cases, English(Required)

Please enter a number from 0 to 16.

Number of Cases, Spanish(Required)

Please enter a number from 0 to 16.

How did you learn about the Charlie's Kids book donation program?(Required)

If awarded, will these books be used in/with research? If so, please explain.(Required)

Is your effort/program part of a larger infant mortality reduction effort? If so, please explain.(Required)

Have you ever applied to the Charlie's Kids book program before?(Required)

Yes

Have you previously been awarded books through this program?(Required)

Yes

If so, please share the month and year awarded?

(Note, if your organization received books within the last 3 years, you are not eligible yet.)

Do you agree to participate in surveys and share pictures from your safe sleep campaign if you are chosen to receive books?(Required)

Yes

Books shipped to the attention of(Required)

Shipping Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country