Book Grant Application Organization Name(Required) Tax ID Number, if applicable Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. 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)Reward for Education ClassesBaby ShowerPrenatal/Postnatal VisitResearchHome Visiting Educational ToolHospital Safe Sleep ProgramOtherWill the books be used for a one-time campaign or long-term effort? If long-term, please indicate the timeline for the campaign.(Required)One-Time1 - 6 months7 - 9 months10 - 12 monthsUnsureOtherPlease 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 No 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)How many cases of books are you requesting?(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)We are always interested in learning and growing in our understanding of infant mortality and effective measures in safe sleep advocacy and barriers in communities around the country. If possible, can you share the following: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 No Have you previously been awarded books through this program?(Required) Yes No 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 No If awarded books, please indicate to whose attention the books should be shipped and where. Please note that books can only be shipped to a single location.Books shipped to the attention of(Required) Shipping Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country