Name *

First Name

Last Name

Relevant Area(s) of Mission *

Check all that apply.

Health care

Education

Health care advancement initiatives

Patient advocacy

Health care awareness promotion

Medical research

I understand that I (or representative) must give an update on the progress of the project when prompted by the Women's Board. *

Yes

I understand I must acknowledge the Women's Board when communicating about the project with internal or external audiences. *

Yes

I understand I must be proactive in inviting the Women's Board to participate in engagement opportunities, when appropriate. *

Yes

I understand I must inform the Women's Board of any change in project plans or budget. *

Yes

I understand I may be asked to return unused funds if my project plans change. *

Yes