Community Innovation Exchange
Tell us about your self.
The Project You are Submitting to the Community Innovation Exchange
What is the BIG problem that your project addresses?
What are the cities where this project is focused on supporting?
In your own words, how wide does your location /mission reach?
(Example, we reach a 15 mi. radius, our mission effects people within 3 blocks, we work in the entire DMV area)
What is the size of your organization?
What do you need to make this project successful ?
Section1: Tell Us Your Project.
What were the conditions in your community that led to the start of this?
Why is Your Organization Leading this Project?
(i.e., the journey, history, etc.)
How does this project improve the health of the community?
(include data/statistics, etc.)
What type of challenges did you face when activating this project?
What is the best scenario for how this project evolves?
Why are you committed to seeing this project through to its completion?
JUST ASK: As you’re working this project, what do you need to make this project successful?
Section 2 : Case Studies, Testimonials and Impact
Submit Any White Papers, PowerPoint Slides, etc
Please share your social media platform URL's and followers.
(example https://www.facebook.com/EmPoweredToServe/ 1000followers)
Type a question
Media acknowledgements/press (blogs)
Company Website- enter a valid website URL
for example http://www.google.com
Section3: Demographics and Background Data
Does your organization have volunteer opportunities?
Please share the volunteer opportunities.
Have you worked in any capacity with the American Heart Association (AHA) and/or received prior funding from the AHA? If so, please describe
Does your business have any of the certifications below (check all that apply) ?
MBE– Minority Owned Business
WBE– Women Owned Business
DBE– Disadvantaged Business Enterprise
VOSB- Veteran-Owned Small Business
SDVOSB– Service-Disabled Veteran-Owned Small Business
Does your concept/submission have a patent?
Is your patent currently being challenged or are you in current litigation with other organizations or entities?
How did you hear about the CIE?
I agree to receive the ETS newsletter ( optional)
I certify that I am authorized to release this information to the American Heart Association and agree that any information provided to the AHA, whether as part of this intake form or otherwise, may be disclosed by the AHA and that I have sufficient rights, whether by implication, estoppel, or otherwise, to grant AHA the rights discussed in this form
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