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AED Matching Grant Form

Heart attack is the leading cause of death in the Fox Valley region, and in the United States. AEDs, or automated external defibrillators, save lives. Placement of AEDs in emergency response vehicles, public areas and local business is the focus of the Gold Cross Ambulance HeartStart Foundation.

HeartStart provides AEDs to municipalities of all sizes and to all kinds of organizations, as well as assists in placing AEDs in public locations in the Fox Valley. The HeartStart Foundation fund, held and administered by the Community Foundation for the Fox River Valley Region, helps pay for AEDs. AEDs cost about $1,800 each.

Since the program began in 1998, Gold Cross has assisted in the placement of more than 300 AEDs in the Fox Valley and broader region. Publicly accessible AEDs are located in downtown Appleton, Neenah and Menasha, as well as in smaller municipalities in the region, and scores more are used by law enforcement and other emergency responders.

Thanks to the HeartStart Foundation and community support, the Fox Cities have the most AEDs per capita in Wisconsin.

Gold Cross provides AED matching funds to organizations that want to purchase and place AEDs and trains community members and local businesses in CPR and AED use. To apply for an AED matching grant for your organization please fill out the below form.

Automated External Defibrillator (AED) Program Matching Grant

Organization and Contact Information

Organization Name *

Organization Address *

County in which organization is located *

Supervising Official *

Contact Person *

Contact Person Email *

Contact Person Phone *

Fax Number

Organization’s Corporate & Tax Status *

Organization Staffing *

Approximate Number of Personnel *

Annual Equipment Budget *

Total Annual Budget *

Organization’s Geographic Service Area *

Service Area Square Miles *

Nearest Large or Medium Sized City *

Other Funding Sources for this AED Fund Request

How Your Organization Will Use the AED

Does your Organization currently own or have access to an AED? *

Yes

If so, how many and what type of AED(s)? *

Is this application for a replacement AED? *

Yes

If your organization is awarded a matching grant for an AED, for what major purpose(s) will it be used? *

If your organization is awarded a matching grant for an AED, where will it be placed and primarily used? *

Knowing that other organizations will be competing for a limited number of AED matching grants to be awarded by the Gold Cross HeartStart Fund, please describe how your organization intends to use the AED and/or how it will improve your emergency response or other capabilities? *

Please site specific examples within the last three years where an AED would have enhanced your organization’s response. *

Is there any other information that your organization would like the selection committee to consider? *

How did you learn about this AED matching grant program? *

If you are human, leave this field blank.

AED Grant

AED Matching Grant Form

Organization and Contact Information

How Your Organization Will Use the AED

Dispatch

Billing

Fax Number

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