AED/CPR Donation Application

Name of Organization (referred to herein as “Applicant”):

Name of contact person:

Telephone number of contact person:

Email address of contact person:

Address:

EIN and other identification number:

AAU Membership Number:

*ONLY AAU SPORTS TEAM MEMBERS HAVE TO PROVIDE AN AAU MEMBERSHIP NUMBER AND EIN. THANK YOU.

In order to be a recipient of an AED donation from the Foundation, please provide a copy of the IRS determination letter indicating that your institution is a 501(c)(3) organization or provide other proof or explanation that the organization is a non-profit entity.

Organization’s website address (if any):

Name, title, and contact information for the person who will sign the AED / CPR Donation Agreement (note that this must be someone who has the authority to sign contracts and legally bind your school or institution):

Does your school or institution currently have an AED or any other life-saving equipment on its premises? Has your school or institution previously received CPR training? If so, please describe.

Is your school district or institution required to work with a specific AED manufacturer? If so, please describe.

In approximately 300 words please describe below what the meaning of life is to your school or institution and the benefits of having life-saving technology and equipment readily available to help support members of the community in achieving the dream of living life to its fullest.

If selected as a recipient, which (1) AED package will your school / institution select or if applying for CPR/ AED certification please select EMS Safety CPR/AED Services:
Heartsine Samaritan PackagePhilips HeartStart OnSite PackageZoll AED Plus (ONLY OFFERED TO AAU SPORTS TEAMS)EMS Safety CPR Two Year Certification

Does the device need a Wall Cabinet?
YesNo

Anything else you would like us to know about your school or institution (may be left blank):

Please do not submit any video or photographic materials with your application. Please note that we are not able to return any materials you send us. By submitting this application, you acknowledge that all information contained herein is true and correct on the date of submission and that you are authorized to submit an AED Donation Application on behalf of your institution. Further, you grant the Foundation a license to use, reproduce, transmit, distribute and display your AED Donation Application and all information and content in the Application in connection with the Foundation’s activities, including, without limitation, publicizing awards and its programs generally on its website or in other media.

** Please add grants@hopeysheart.org to your list of safe senders to avoid emails landing in your spam folder