General InformationName of Applying Entity*Please note that this MUST be the entity that holds the contract for engagement in the AIM Program. Any funds received will be made payable to this entity. Applying Entity Type*AIM PartnerAIM StateAIM SystemSelect one.Which AIM state does the applying entity represent?*Does the applying entity currently have an active contract for activities related to the AIM Program?*Yes, we have an active contract with ACOG for AIM.No, we do not have an active contract ACOG for AIM.Contact InformationPrimary Contact Information* First Last Title This individual will be contacted with results of funding request.Primary Contact Email* Enter Email Confirm Email Primary Contact Phone*Project InformationAmount of Total Funding Requested*The total amount of funding being request to support project proposal described in narrative. Please note that requests of all amounts will be considered but it is recommended that requests be between $10-$20K total. Project Narrative*Accepted file types: pdf, doc, docx.Upload a copy of your detailed project narrative here. For narrative requirements see the Detailed Description and Rules. This iframe contains the logic required to handle Ajax powered Gravity Forms.