First Name
*
Last Name
*
Job Title
Phone
*
Email
*
Organization
Address
City
State
Postal code
Website
Organization Overview
Type of Organization
School
Sports Team/League
Community Group
Other
Other Type of Organization
Number of Individuals Served by Organization
Does your organization currently have any AED devices?
Yes
No
How many AED devices?
Have your staff/volunteers received CPR or AED training?
Yes
No
AED Need and Usage
Please explain why your organization is in need of an AED
Does your organization have an Emergency Action Plan (EAP) in place for cardiac emergencies?
Yes
No
In development
If awarded an AED, how do you plan to implement it within your organization?
How will having an AED benefit your community or participants?
Additional Information
Does your organization have the financial resources to maintain the AED (e.g., battery replacement, pads, etc.)?
Yes
No
Has your organization received any previous donations from Bailey's Heart and Soul Foundation?
Yes
No
Are you interested in partnering with Bailey's Heart and Soul Foundation for future CPR or AED training programs?
Yes
No
Optional: Upload a letter of support or recommendation from a community member or partner
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