MDS Foundation Ambassador Grant Application

Name:
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Address 1:
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Address 2:
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City:
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State:
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Zip:
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Preferred Email Address
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Preferred Telephone Number:
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Request grant amount (You may request up to $2,000)
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The following dental professionals will assist me in project implementation (Dentists must be MDS members)
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Estimated total project cost, itemizing how the grant funds will be spent (Please include in-kind and/or matching grants in the total project cost)
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Describe the purpose and duration of your project
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Describe the project objectives and planned activities
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How will progress and success of the project be measured?
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