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2. SHIP Community Partner Award Application 2025

   Prior to completing this application, please review the Anoka County SHIP Community Partner Award Instructions. Any questions about the application can be sent to SHIP@anokacountymn.gov or call 763-324-4200

   Before you complete the form, review the details of the SHIP Community Partner Award Proposal

4. Anoka County SHIP Community Partner Award Instructions
   View instructions here
8. Organization / Group Information
10. Today's Date*
11. Organization/Group Name*
13. Organization/Group Address*
15. Name of Primary Contact*
16. Phone Number of Primary Contact*
18. Address, City, State and ZIP of primary contact's work location*
20. Email Address of Primary Contact*
21. What is preferred method of contact?

    1. Phone
    2. Email
23. How did you hear about Community Partner Awards?

    1. Email
    2. Newsletter

    1. Newspaper
    2. Website

    1. Word of Mouth
25. Other (please describe)
29. Which option best describes your primary organizational structure?

    1. For-profit
    2. Non-profit 501(c)3

    1. Non-profit - Other*
    2. Public Agency/Government
31. *Other:
33. Which options best describe your organization's industry or primary focus?

    (Mark all that apply)

    1. Retail
    2. Manufacturing
    3. Human Services
    4. Sales/Consulting
    5. Business Services
    6. Insurance
    7. Real Estate/Housing
    8. Information Technology
    9. Environmental Services
    10. Finance

    1. Arts/Creativity
    2. Advocacy/Outreach
    3. Utility
    4. Vocational Training
    5. Higher Education
    6. Agriculture
    7. K-12 Education
    8. Healthcare
    9. Trades/Construction
    10. Other**
35. **Other
37. Setting for Project

    1. Childcare
    2. Community
    3. Health Care
    4. Workplace
    5. School
39. Primary Context for Project

    See instructions for what each selection includes in detail.

    1. MN EATS (Healthy eating, lactation support, etc.)
    2. MN MOVES (Movement, physical activity, biking, etc.)
    3. MN Breathes
41. History or pertinent background of organization, including any wellness initiatives:*
43. Are you currently working with a SHIP Staff member?

    1. Yes
    2. No
45. If yes, who are you currently working with?

    1. Elizabeth Hagen
    2. Gretchen Etzler
    3. Megan Barry
    4. Tonayo Crow
    5. Zoey Doto
47. Other:
53. Project Information
55. Project Goal(s)*

    What are the goals of the project? How will this project address the need?

57. Description*

    Why is this project needed at your organization? Provide a general description of the project.

59. Please describe what Policy, System, or Environmental Change(s) this project will address.

    See instructions for descriptions of each.

61. Policy:
62. System:
63. Environmental:
65. Health Equity*

    How does this project improve health equity?

67. Number of people who will benefit from this project:
69. How will this project benefit the community?
73. Action Plan and Timeline
    List the activities needed to accomplish the project and the timeline for completing them. Add more lines as needed.
75. Action Plan/Activities
76. Timeline
78. Action Plan/Activities
79. Timeline
81. Action Plan/Activities
82. Timeline
84. Action Plan/Activities
85. Timeline
87. Action Plan / Activities
88. Timeline
90. Action Plan / Activities
91. Timeline
93. Action Plan / Activities
94. Timeline
96. Action Plan / Activities
97. Timeline
99. Feel free to attach a document with more lines as needed.
103. Evaluation Plan*
     What would indicate to you that this project was successful?
105. Ship requires all projects to include evaluation. Are you willing to work with SHIP staff to come up with an evaluation plan?*

     1. Yes
     2. No
107. Sustainability*
     What is the plan for making sure the project continues after funding ends?
109. Communications*

     Who needs to know about this change? (leadership, employees, clients/patrons/parents/students, general public) How will you communicate with these groups?

111. Budget
     Include all projected budget items, such as equipment, materials, training fees, printing, etc. Add more lines as needed. Please include links to specific items as needed. All approved and agreed upon items will be purchased directly by Anoka County SHIP.*
113. Attach Completed Budget and Order Form

     Anoka County SHIP Community Partner Awards Budget Form

114. Total Amount Requested:*
116. * SHIP funding cannot be used for alcohol/illegal substances, capital improvements, clothing, lobbying, fitness center memberships, raffles, etc. Approval of items is determined by the MDH SHIP Financial Guidance and Anoka County SHIP discretion.
120. By signing the Project Application, you agree:

     (no need to check these boxes)

     1. Obtain leadership and, if convened, wellness committee support for proposed SHIP project.
     2. Ensure the project implementation and any final products as a result of the project are located in Anoka County, MN.
     3. Submit a completed budget form and return correspondence with SHIP in a timely manner regarding changes, alterations, or clarifications within 5-10 business days.
     4. Complete a Memorandum of Understanding, if required, per Anoka County or MN Dept. of Health.
     5. Complete a media release providing consent to Anoka County SHIP and its partners to share media regarding your project or organization with the public.
     6. Complete the SHIP Project Survey once the project is complete.
122. Signature*
     Type your name to confirm you've read and agree to the requirements.
123. Date*
     Date

125. For questions about the application, including assistance in completing the application (additional formats, translations, etc.) please email SHIP@anokacountymn.gov or call 763-324-4200. 

Leave This Blank:


127. 1. Receive an email copy of this form.
128. Email address

     This field is not part of the form submission.

129. Submit

* indicates a required field