Please complete the form below.
Does OraSure Technologies have your permission to use your name, institution/company and project name for marketing purposes in the event your project is selected as a winner? Yes No
Are you willing to participate in a presentation (webinar, poster, affinity session) about your program? Yes No
Are you willing to provide a short update every three (3) months about the status of your program? Yes No
Do you have all the necessary approvals/permissions required to apply for the OraQuick HIV Testing Grant? Yes No
Do you agree to the OraQuick HIV Testing Grant program rules and the Terms and Conditions Yes No
Your preferred method of distribution: Direct Online Retail Access Card Combination (Please explain in your proposal)
Please describe the scope and significance of your project and how does it complement your existing testing program. Include a statement about how you will measure the success of your project and your start/end date. (Limit 500 Characters)
Who is your target population and based on the distribution method you chose, how will you reach them? (Limit 500 Characters)
How many OraQuick In-Home HIV Tests are you proposing to use (maximum quantity: 500)?
What level of funding are you requesting to support your project? (maximum $5,000.000)
How will the grant funds be used? (funding may not be used to purchase test kits; Limit 500 Characters)
If you are using OraQuick Advance HIV 1/2 Antibody Test, please tell us how many you will need.(Max 200, 0 for None)
How many HIV+ individuals do you expect to identify with your project and how will you ensure that they are linked to care and treatment? (Limit 500 Characters)
Please use this space to tell us anything else about your organization or project that you would like us to know. (Limit 500 Characters)
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