Community AED Grant Application - Medic One Foundation

Medic One Foundation offers a limited number of grants for the purchase of Automated External Defibrillators (AEDs) to be placed in public areas such as local government facilities, community centers, playfields, parks, and law enforcement vehicles within King and Snohomish counties. Priority will be given and grants awarded based upon demonstrated financial need, population served, location, and potential impact. Organization must be a 501 (c) 3 tax-exempt organization or government entity. Placement of AED(s) must be located within King or Snohomish counties. No organization will receive funding in two consecutive years.

Organization Contact

Applicant Organization:(Required)

Type of Organization:

501c3

Government

Other

Contact Person:(Required)

First Last

Title:

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Phone:(Required)

Email:(Required)

Funding Request

Funding will be on a matching basis. The Medic One Foundation may contribute up to 75% of the cost of the AED(s). Please list only the total amount of requested funds by category on this page. Attach an itemized list of expenditures for equipment, training, or other. Requests totaling $2,000 or more must include two vendor bids verifying the cost of each item.

AED Equipment: Amount Requested(Required)

AED Equipment: Matching Funds(Required)

AED Equipment: Total Cost

Price: $0.00

Other: Amount Requested

Other: Matching Funds

Other: Total Cost

Price: $0.00

TOTAL AMOUNT REQUESTED:

Price: $0.00

TOTAL MATCHING FUNDS:

Price: $0.00

TOTAL COST:

Price: $0.00

Please include the following information in your proposal.

Equipment Item(s) requested:(Required)

Does your organization currently have an AED? If so, what is the brand and age?(Required)

Describe the need and how/where the AEDs will be used (e.g. stadiums, arenas, park, playground, auditorium, classroom):(Required)

Will this AED be accessible to the public (e.g. placed or carried to public locations where it could assist a non-member or spectator of your organization)?(Required)

Yes

Will this AED be accessible to the public - NO: Please Explain(Required)

Why is this funding needed at this time? What will happen if you do not receive the funding?(Required)

Who will be responsible for storing and maintaining this AED:(Required)

If the AED will be used as a portable device, please describe how the machine will be stored when not traveling with the group.(Required)

If your request is funded, how will you acknowledge or recognize the Medic One Foundation?(Required)

Would your organization/team be interested in CPR/AED training?(Required)

Yes

Agency information

Number of employees:(Required)

Number of volunteers:(Required)

Demographics Served by your organization:(Required)

Youth (0-17)

Adult (18 and older)

Both

Area(s) served (zip codes):(Required)

Budget

Please identify the source of matching funds(Required)

Annual Budget for current year of 2024:(Required)

Please indicate the total dollar amount of charitable gifts your agency received in the last fiscal or calendar year:(Required)

Do you have a budget for maintenance costs (e.g. replacement of batteries and pads)?

Yes

If you are requesting a grant for more than one item, please provide a detailed listing of your funding request, along with individual costs and attach quotes for those items over $1,000.

Any other information you would like to share, that we should know when we consider funding for this project?

Medic One Foundation requests information regarding the operating budget of applicant organization in order to assess relative need for funds. In addition to the information requested above, the applicant organization is invited to provide further data regarding financial need.

FOR ITEMS COSTING $2,000 OR MORE, PLEASE UPLOAD VENDOR BID(S) HERE: BID ONE

Accepted file types: doc, pdf, txt, gif, jpg, jpeg, png, Max. file size: 21 MB.

FOR ITEMS COSTING $2,000 OR MORE, PLEASE UPLOAD VENDOR BID(S) HERE: BID TWO

Accepted file types: doc, pdf, txt, gif, jpg, jpeg, png, Max. file size: 21 MB.

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