Social Determinants of Health Funding Request

Approved Community Health Workers should complete all the fields below to submit a funding request on behalf of their clients.

Once you enter in all of the required information and click submit, an e-mail will be sent to United Way staff to review the request.

The information is divided into four separate sections:

Partner Organization
SDH Request

For additional questions, call United Way staff at 765-608-3060.  If you need to submit additional supporting documents, email them to Karen Hemberger,, or fax them to 765-608-3065, ATTN:  Karen.

Request Information

$200 Automatically approved; $500 cap

Client Information

Vendor Information

For reimbursement, enter your organization as vendor