1 Organization Information 2 Project Details 3 Project Funding 4 Project Impact 5 Upload Files 6 Summary Step 1: Organization Information * Denotes required field *I/We acknowledge that this program/project/initiative meets the funding criteria and does not include expenses ineligible for funding. *Organization Name: Legal Name (if different from above): *Contact Person: *Contact's Job Title: *Email Address: *Contact Phone Number: *Mailing Address: *City: *Province: BC AB SK MB ON QC NB NS PE NL YT NT NU *Postal Code: Website URL: Org/program/project social media handles: *Year your organization was founded or incorporated: Are you a not-for-profit organization? Are you a registered charity? Are you legally authorized to provide the programs/services for which you seek funding? Are you able to provide audited financials? Please do not submit unless requested. *Please acknowledge that your organization serves our diverse province in an inclusive and equitable manner, reflecting diversity of sex, sexual orientation, gender identity or expression, racialization or ancestry, disability, political belief, religion, marital or family status, age, and/or status as a First Nation, Metis, Inuit, or Indigenous person. *Briefly describe your organization’s mission, vision, and mandate: Are you governed by a board of directors, council, or committee? Have you spoken to anyone at Pacific Blue Cross about this request? Have you received funding from the Pacific Blue Cross Health Foundation in the past 24 months? Save & Exit Next
