Please review the information below. If everything is correct, click “Send”. To go back and edit your entries, click “Edit”.
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We ask that all individuals and organizations who are interested in completing the MHCP Health Improvement Fund letter of intent please complete the form below. You will not be able to save this form and come back to it later. We recommend writing longer answers in Word and copying and pasting into the form. Narrative boxes can be expanded by clicking on the bottom right corner of the box and expanding down.
Agency/Program Information
Agency Name:
EIN:
Chief Staff Officer Name:
Chief Staff Officer Email:
Primary Contact Name:
Job Title:
Primary Email:
Primary Phone:
Program Information
Program Name:
Funding Amount Requested:
Program Narrative
Select the activity purpose that most aligns with your project (select one):
Provide a program description, need for and purpose of funds, indicating how the funding will be aligned with the Milwaukee Health Care Partnership priority to increase access to mental health care services for low-income, underserved populations in Milwaukee County. (Supported activities include mental health and substance use programs and services that focus on early identification and intervention, outpatient diagnostics and treatment, crisis intervention, and care coordination for people of all ages.)
Describe the priority population that the program will serve including geographical area for service delivery. Please include anticipated number served by the program between July 1, 2025 and June 30, 2026.
Briefly describe your organization's commitment to diversity & inclusion and how the program promotes health equity.
Note: Click the submit button when the form is completed. The next page will confirm that the form has been submitted and the primary email will receive a confirmation email.