Apply for MedMissions | Inteleos Foundation

MedMissions Grant Application

Thank you for your interest in the MedMission™ award, a philanthropic initiative sponsored by the Inteleos Foundation’s MedMission Grant. The MedMission Grant offers financial resources to a selected non-profit organization, with the purpose of expanding ultrasound to new communities through year-long implementation. MedMission awardees should have a well-designed project plan to introduce Ultrasoundinto a limited-resourced environment with the ability to track health outcomes. Examples of past projects can be found on our website.

Note: All 2024 MedMission awards will be prioritizing programs lacking access to ultrasound equipment.

To be considered for MedMissions and apply for MissionUltrasound 2024, please complete the application below. Electronic signatures will be accepted within this form. Any supplemental application materials must be returned to Foundation@inteleos.org by September 30, 2024, to be considered. Applicants will be notified by October 31, 2024.

"*" indicates required fields

Organization Information

Organization Full Name*

Website*

Address*

Business Address City State / Province / Region ZIP / Postal Code Country

Year in Operation*

Number of Staff*

Is this a 501(c)3 organization in good standing?*

Yes

Primary Contact Information

Name*

First Name Preferred Name Last Name Suffix

Email*

Phone*

Position/Title*

Project Proposal

Descriptive Title*

Start Date*

End Date*

Project Site Location

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

About your Project

If awarded this grant, please describe the project you envision. (min: 250 words)*

Please describe the need for ultrasound equipment in your practice environment. (min: 250 words)*

What will be the outcomes of the proposed project? (min: 250 words)*

What is the potential impact of the proposed project? (min: 250 words)*

Agreement to Terms

By signing this application, I certify that the statements herein are true, complete, and accurate to the best of my knowledge. I and my organization agree to comply with any resulting terms as requested by the Ultrasound Academy and Inteleos Foundation upon my acceptance. I am aware that false or fictitious statements will invalidate this application and eliminate my organization from current and future MedMissions or MissionUltrasound projects.

Applicant’s Signature

Printed Name*

Date*

If not selected for MedMissions in 2024, would you like to be considered for future Inteleos Foundation granting opportunities?*

Yes

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