Application Letter of Intent

Prior to applying, please send a non-binding Letter of Intent to elizabeth.bingman@fammed.wisc.edu to briefly outline the intended project, budget requirements and expected outcomes.

The Letter of Intent must include the following information:

  • Type of grant requested (Operational or Transformation)
  • Name and location of interested applicant organization and partners, if any
  • Name, title, email address and telephone number of the primary contact
  • Targeted specialty (family medicine, general surgery, internal medicine, obstetrics, pediatrics or psychiatry)

Application Materials

All applications must be typed, double-spaced and sequentially numbered.

A complete application includes:

  1. Application Form

(either the Operational Grant Form OR the Transformation Grant Form)

  1. Proposal Narrative (not to exceed 10 pages)
    • Description of Activities and Impact on Resident Physicians in Rural Communities
      • Anticipated Outcome
      • Rationale
      • Program Planning
      • Rural Focus
      • Sustainability
  1. Timeline (1-2 pages)
    • Benchmarks/Objectives
    • Start/End Dates
  1. Budget & Budget Narrative (spreadsheet)
    • Brief description of Items and Rationale
    • Amount and Calculations
    • Other Funding Source(s)
  1. Supporting Documentation (optional)
    • Price Quotes, Data Sheets, etc.

An electronic copy of the complete application must be sent to elizabeth.bingman@fammed.wisc.edu no later than 4:00 PM of the proposal due date.

Applicants will receive a confirmation receipt within 24 hours of the closing date and time.

Any applications received after the deadline will not be considered, and – unless requested – no additional information will be accepted.


Other Forms