Forms

2. 

3. DeKalb Firefighters Union

   Local 1236
   AED Grant Application

4. 

6. The DeKalb Firefighter Union Local #1236, in cooperation with the DeKalb Fire Department, is sponsoring a community Automatic External Defibrillator (AED) matching funds grant program. It is our hope this program can be a first step in making DeKalb a “HEARTSafe Community.”

8. Eligibility Requirements

   Business or organization must

   • Be located within the City of DeKalb limits or the DeKalb Fire Protection District;

   • Comply with FDA requirements and documentation and maintenance of the AED;

   • Be willing to allow name of business or organization to be used for ongoing public relation campaigns; and

   • Have the ability to contribute 50% in matching funds toward the purchase of the AED.

   Application Process

   1. Complete the application below, and submit it to the selection committee.

   2. The selection committee will review all applications and notify applicants of its

   decision in a timely manner.

   3. The DeKalb Firefighters Local #1236 in conjunction with the DeKalb Fire Department will assist your organization in initial and ongoing training.

10. The APPLICATION PROCESS does not discriminate against race, sex, religion, national origin, or sexual orientation. The selection committee reserves the right not to award in any given year. If you have any questions regarding this program please contact DeKalb Fire Department at 815-748-8460 or send an email to fire.ems@cityofdekalb.com or president@iaff1236.com.

12. AED Grant Application
14. Name of Business/Organization
16. Address
18. Contact Person(s) requesting AED
19. Business Phone Number
21. Cell Phone Number
22. E-mail
24. 1. How did you hear about the DeKalb Fire Community AED Program?
26. 2. Why should your organization be considered for an AED?
28. 3. How and where will the AED be used/placed?
30. 4. Will you need AED training for your organization?
32. 5. Has your organization been directly affected by Sudden Cardiac Arrest?
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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

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