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2024 Community Civic Engagement Program Application

The Community Civic Engagement Program (CCEP) is Vot-ER’s flagship grant-making initiative that expands non-partisan civic engagement within community health centers — including voter registration and turnout. By partnering with you, different Community Health Centers, Federally Qualified Health Centers, and other look-alikes, we can build healthier communities by promoting civic engagement through the use of trusted messengers.
Applications are due March 11, 2024 by 5PM PT.
You will be able to save your progress throughout the application. Responses are saved in your browser and never leave your computer.

1. Organization Name

Please use your organization's full name, without abbreviations

2. Organization Type

If your organization type is not listed, select "Other"

3. How many patients does your community health center serve?

4. The majority of my patients are (select all that apply):

4. The majority of my patients are (select all that apply):

5. My institution views itself as a space that is designed to serve (select all that apply):

5. My institution views itself as a space that is designed to serve (select all that apply):

6. Community Health Center Mailing Address

7. State

8. Zip Code

9. Occupation

If your occupation is not listed, select "Other"

10. Organization Phone Number

11. Organization Website

12. Organization Social Media Handles

Please include all that are applicable

13. Please upload your organization's logo with a transparent background in a .png format

14. Point of Contact Information

15. Point of Contact Title/Position

16. Point of Contact Email

17. Point of Contact Phone Number

Please provide contact information for a backup contact at your organization

18. Backup Contact Name

19. Backup Contact Title

20. Backup Contact Email

21. Backup Contact Phone Number