MDS Foundation Ambassador Challenge Grant Application

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