Please fill out this form and submit. Name of Organization*Contact Name* First Last Email* Phone*Select a category that best describes the project/program for which support is being requested.*DENTAL EDUCATIONDENTAL SERVICESUPPLIES AND EQUIPMENTStart Date* Completion Date* Who and how many will benefit from this program/project?*How will you evaluate the success of the program/project?*Describe other grants you have received from the WMDF.Are monies being received or requested from other sources to fund this project/request?YesNoPlease explain:If the WMDF does not provide funding, how will you proceed?Write a descriptive narrative of the proposed program/project.Include your goals or objectives and the expected accomplishments. Explain how the program/project is in keeping with the mission statement of the West Michigan Dental Foundation. Provide any other information that may be helpful in guiding the board’s decision.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.