Thank you for contacting the Office of Health Parity to support your program, initiative, activity or event geared towards advancing a culture of belonging at UI Health Care. Your request will be reviewed within 2 weeks of submission. Should your request be funded, you will be required to submit an evaluation of your program, initiative, activity or event within 30 days. Who is requesting funding? Today's Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Name * Email * Department Program/Activity/Event Description Date of Proposed Program/Initiative/Activity/Event Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Description of Program/Initiative/Activity/Event Which UI Health Care strategic diversity goal will this Program/Initiative/Activity/Event support (select all that apply) Build pathway for students/trainees underrepresented in medicine and foster a culture of inclusion. Recruit, retain, and advance a diverse group of faculty, staff, and volunteers. Enhance equity, effectiveness, and fairness into UI Health Care. Support students with disabilities. Describe how this program/initiative/activity/event will support your department's and UI Health Care's strategic plan. Expected Outcomes Estimated Number of Attendees or Participants (if applicable) Estimated Total Budget Indicate the amount that your department/unit is contributing toward this program/initiative/activity/event Funding Requested from Office of Health Parity How will the money be used? Additional Comments CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.