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AtlantiCare Heart Heroes AED Matching Funds Program
  1. A partnership to place automated external defibrillators (AEDs) in our community

    The ARMC Heart Heroes is a volunteer group that raises funds for The Heart Institute at ARMC through the AtlantiCare Foundation.

    • Organizations requesting an AED upon approval of matching funds must:
    • Notify local Emergency Medical Services office that it holds an AED
    • Have a licensed physician or medical authority provide medical oversight to ensure quality control
    • Have personnel responsible for using the AED certified in CPR and use of an AED
    • Conduct programs or services for the public where there is potential for emergency response to a heart attack

    *Meeting criteria does not confirm matching funds will be granted.
    (Matching funds program - $600 per AED)

  2. Full Name(*)
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  3. Phone(*)
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  4. Your E-Mail(*)
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  5. Your Organization(*)
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  6. Your Title(*)
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  7. What area of concentration does your organization fall under?(*)




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  8. If Other?
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  9. Are you a 501(c)(3) organization?(*)


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  10. Your 501(c)(3) Number
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  11. Address(*)
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  12. Suite/Apt
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  13. City(*)
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  14. State(*)
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  15. Zip(*)
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  16. Number of persons served by your organization annually(*)
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  17. Is your organization funded by the United Way?(*)


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  18. Where will the AED will be placed?(*)
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  19. Does your organization have $600 in matching funds?(*)


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  20. How many staff/volunteers hold current certification in CPR/AED?(*)
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  21. Identify the licensed physician or medical authority that will provide medical oversight to ensure quality control of the AED(*)
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  22. Please describe need(*)
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  23. As an authorized representative of the organization, I acknowledge that if selected by the Heart Heroes AED Matching Fund program, AtlantiCare will supply my organization with an AED upon receipt of payment of the organization’s portion of the cost of the AED. The organization acknowledges that it is solely responsible for training individuals on the use of the AED, security of the AED and maintenance of the AED, and that AtlantiCare is not a supplier or manufacturer of the AED. Please enter your initials as a signature for this form.(*)
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  24. Anti-Spam(*)
    Anti-Spam
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