PUBLIC HEALTH SURVEY

INVESTING IN MONTGOMERY

Montgomery Thrive is excited to invite local businesses, nonprofit and faith-based entities, and healthcare providers to provide feedback on how the pandemic impacted their business operations.

This feedback will be utilized to help local leaders develop programming and projects designed to support the most pressing needs of the community. Before completing the survey, please take a moment to review the FAQ section of the website and read the overview of the Interim Final Rule for further clarity on how these funds can be expended.

WHO SHOULD COMPLETE THE PUBLIC HEALTH SURVEY?

Any healthcare provider with a physical location in Montgomery County that would like to share how their healthcare operations were negatively affected by the pandemic. If you have questions, contact us at questions@montgomerythrive.org.

Name *

Organization Name *

Email *

Address *

Address Line 1

City

State

Zip Code

Website

How has your healthcare program/practice been impacted by the COVID-19 public health emergency? Please provide specific examples.

Please estimate the negative economic/financial impact COVID-19 has had on your healthcare program/practice. Details are encouraged.

Explain specific ways in which the Montgomery Thrive program could provide support/aid to your healthcare program/practice.

Please choose the category that best describes your healthcare program/practice

Is there anything else you’d like to share with the Montgomery Thrive program?

Please attach any documents you would like to share with Montgomery Thrive.

Click or drag a file to this area to upload.

I understand that completing this form in no way represents a guarantee or commitment that my project idea will be utilized or funded, in whole or in part. I further understand that project ideas submitted through the Montgomery Thrive portal may be implemented by way of direct allocations, sealed bids, or requests for proposals. I acknowledge that any project(s) funded through Montgomery Thrive will have to meet a series of criteria based on the rules and guidelines provided by the U.S. Treasury, which may include without limitation the following: 1) Meet at least one of the categories of allowable expenses under the American Rescue Plan Act Interim Final Rule, 2) Provide a copy of associated business formation documents, including any required filings with the city, county and state, as well as a federal employer identification number, 3) Provide proof of registration with SAM.gov Provide proof of registration with E-verify Alabama, 4) Provide a detailed budget outlining proposed project expenditures and timelines, 5) Demonstrate prior experience managing and/or implementing programs in similar size and scope, or 6) Demonstrate prior experience managing and/or implementing programs that involve federal funding. *

Please check this box to acknowledge your review and acceptance of the aforementioned information.