jgerard@cityblm.org
309-434-2450
Thank you for your interest in the Fiscal Year 2027 (May 1, 2026-April 30, 2027) John M. Scott Health Care Trust Category III-Emergent Need grant program. If you have any questions or encounter problems with the application, please contact Joni Gerard (309-434-2450, jgerard@cityblm.org). Applications are due on 02/27/2026 by 11:59 PM. Late applications will not be accepted. Paper applications will not be accepted. You are required to answer any question with a red asterisks (*).
Please certify that all of the below apply to your organization. Failing to check all boxes will disqualify this application from consideration
By checking this box, you certify that the below statement is true for your organization.
Organization Mailing Address
Organization Physical Address (if different from mailing)
Organization Chief Officer Name
Organization Chief Officer Mailing Address
Organization Chief Officer's Office Physical Address (if different from mailing address)
Will the Chief Officer listed above also serve as the main contact for communications related to the John M. Scott Grant? If not, please answer no in order to complete the Grant Lead information questions.
Grant Manager Full Name
Grant Manager Mailing Address
Grant Manager's Office Physical Address (if different from mailing address)
Fiscal Year 2027 Category III Emergent Need Funding Priorities
Service Delivery: Check all the appropriate box(s) below to indicate where in McLean County your proposal will primarily serve.
Select the types of service the lead applicant/fiscal agent currently provides for McLean County residents below the 185% federal poverty line limit.
Please upload a list of your organization's current Board of Directors with the race/ethnicity composition of the entire board.
Which McLean County Community Health Improvement Plan (CHIP) goal will this proposal primarily support? Check all that apply Group
Please select the target audience for your program.
Which of these underserved groups will you directly serve with this grant funding?
Which social determinants of health are most relevant to the work you are proposing?
Select any of the following tools your organization will use to evaluate the success of the work funded by this project/program?
Upload examples or templates of existing evaluation tools you plan to use, if available.
Non-Discrimination Policy
Project/Program Budget The project/program budget must indicate what costs specifically would be covered by Trust funds.
Board of Directors List
Optional Document: Upload your active or most recent strategic plan, business plan, supporting images and videos, job description for any full-time or part-time position (new or existing) supported by this funding request, or other documents you feel will help the committee understand your project better.
The applicant certifies that all statements herein are true, accurate and complete. The applicant will not permit any discriminations on the basis of gender, race, religion, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation, or physical, emotional, or learning disability in connection with its participation in this program. The applicant will ensure that expenditure grant funds are sued for eligible uses under this program. (Type your name and today's date)
