Jax Hope Community Grant Program Application

Applicant Information

Name of organization / group / individual applicant

Primary contact first name

Primary contact last name

Primary contact phone

Primary contact email

Organization address / project location

Brief description of your organization or Parkinson's Disease program.

Project title / description of the request

How does this request directly support people living with Parkinson’s disease?

What specific need does this project address within the PD community?

Who will benefit from this project (estimated number of participants / target population)?

How will this item or project be used in practice?

Total amount requested from JaxHope?

Itemized budget of goods/services to be purchased.

Are there additional funding sources or partners involved?

Timeline for purchase and implementation.

What positive outcome do you expect for the PD community?

How will you measure or describe the impact of this grant?

How will you acknowledge JaxHope’s contribution?

Are you willing to provide a brief follow-up summary or photo after funding is used?

Yes

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