Organization information
Organization name: ________________________________________________________________
Address: ___________________________________________________________________________
Phone: _____________________________________________________________________________
Web address: ______________________________________________________________________
Fiscal sponsor (if applicable): ________________________________________________________
EIN: __________________________________________________________________________
Contact information
Executive Director
Project Director
Name:
Email
address:
Phone
number:
Geographical area served (check all that apply)
Ohio
 Adams County
 Clinton County
 Hamilton County
 Brown County
 Butler County
 Highland County
 Clermont County
 Warren County
 All eight Ohio counties
Kentucky
 Boone County
 Bracken County
 Campbell County
 Gallatin County
 Grant County
 Kenton County
 Pendleton County
 All seven Kentucky counties
Indiana
 Dearborn County
 Franklin County
 Ohio County
 Ripley County
 Switzerland County
 All five Indiana counties
Population served (check all that apply)
Age
 Children (0-17)
Ethnicity
 African American
 Native American
 Adults (18-64)
 All ages
 Asian American
 Caucasian
 Seniors (65 and older)
 Hispanic/Latino
 Other
Organizational description
Please describe your organization below. (Limit to 200 words.) Be sure to include:
 mission/vision
 annual budget
 staffing in FTEs
 relevant history
 current services offered
Proposed event information
Event Title: ____________________________________________________________________
(Check one)
 New event
 Existing event
Planned date (or month) of the event: ______________________________________________
What kind of physical activity involved: ____________________________________________
If recurring event, # of people involved: _____________________________________________
Projected attendance: _____________________________________________________________
Amount requested from Interact for Health: _________________________________________
Top 3 funding sources, with percentage of budget:
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Total event budget: ________________________________________________________________
Participant fee: _______________________________________________________________
Is food going to be offered? Yes _____ No _____
If so, please describe the healthy food options that will be offered at the event. (Limit 50
words)
Event information
In 500 words or less, please describe:
 The history of the event, include demographics and number of participants (if
recurring)
 The nature and length of the proposed event, including the equipment needed
 How your event will support on-going physical activity in our community
 How your event will remove barriers to participation
 How you will engage diverse groups to participate in the event
 How you will determine whether the event was successful
 How participant fees are used (i.e. event costs, fundraising)
 The frequency and anticipated attendance of future events
In the space below, describe how you will market your event.
Marketing your event
In 200 words or less, please describe how you will approach these issues to the
extent that you have thought about them:
 How your event will be marketed, including any specially targeted populations
 How your event will attract ethnic and socio-economic diversity and
accommodate disabled individuals
 How you will address competition with other events
 What communication messages and channels you will use to reach new
participants
 Who your strategic collaborators will be The criteria for consideration are:
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The event must be physical activity based and aimed at ongoing lifestyle
change
The event must be open to the community
The event must be free or low cost
The event must create the opportunity to expand an existing event or reach new
people
The amount requested for the event should match the scale of the event
Funding will range from $500 to $5,000
Health fairs will not be funded
The event will offer healthy food options if food is offered
Please email this Event Sponsorship Application to:
[email protected]