2023 IMPACT Grant Program
Application Form
Step 2: Fill out form below and upload all required supporting materials.
Application Deadline: October 16, 2023

Applicant Information

Applicant status: *

Sponsoring Organization Information

The sponsoring organization is the organization that will receive/manage grant funding if selected as a grantee. Grant funds are disbursed to this organization rather than to the individual applicant. It must be a nonprofit organization (PA program, constituent organization, or other organization with nonprofit status). 
Is this the organization that will receive/manage grant funding (if awarded)? *
Sponsoring organization status: *
Is this organization incorporated? *
Is this organization a nonprofit? (must be a nonprofit in order to meet eligibility criteria) *
Based on the response above, this organization is not eligible to serve as the sponsoring organization for this grant application. Sponsoring organizations must be nonprofit organizations.

Project Information

0/250 words

Required Documents


Applicant Attestations
Please review and indicate your agreement with the following statements by checking the box next to each. *
Digital signature of applicant: *

Sponsoring Organization Attestations
To be signed by main contact at sponsoring organization. If the individual applicant is affiliated with the sponsoring organization, form should be signed by the applicant's supervisor; if no supervisor, applicant may sign it.

Faculty Sponsor Attestations
To be completed only if applicant is a PA student.

Additional Questions

The PA Foundation would like to know more about the individuals applying to our programs. Please provide the following information if you are comfortable doing so, or select “Prefer not to respond.” This information will not be used in the grant selection process.
Do you identify as a sexual or gender minority*? *
*From the National Institutes of Health: Sexual and gender minority (SGM) populations include, but are not limited to, individuals who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex. Individuals with same-sex or -gender attractions or behaviors and those with a difference in sex development are also included. These populations also encompass those who do not self-identify with one of these terms but whose sexual orientation, gender identity or expression, or reproductive development is characterized by non-binary constructs of sexual orientation, gender, and/or sex.
Race/ethnicity (select all that apply): *
Career stage: *

Thank you for completing this application!