Community Grant Request

Allocations Committee Grant Guidelines

Please read carefully before submitting a funding request. The mission of the Community Initiatives Allocations Committee is to respond to community requests through an efficient and intentional process that will provide funds to effectively: - Empower residents of our community to live healthier, safer lives (Health/Human Services) - Enhance the lives of children and in a holistic (physically, psychologically, socially, spiritually) way (Youth & Children) - Educate the community both in basic learning and professional development (Education) - Establish a stronger economic base (Economic Development) - Enrich West Texas culture (Arts/Culture) The committee prefers to fund: - Causes/services/programs rather than events - Groups rather than individuals - Scholarships that are medical in nature and have retention potential at Hendrick - Local causes/services rather than those outside our community Applications are requested 60 days prior to the date that confirmation of approval is needed. Requestors will be asked to submit an annual report to the Allocations Committee regarding use of approved funds.

I confirm that I have read and understand the grant guidelines of the Community Initiatives Allocations Committee.*

Yes

Organization name, event, program, cause or service.*

Date Prepared*

Amount Requested*

Is this an event sponsorship request?

Yes

Event Date

Please follow up with us after the event. We would love to know how the donation was used, how many people benefited and other pertinent details.

Impact Area*

Select

List the ways your cause/service/program supports the Hendrick Mission to serve the community and how the requested funding will be used.*

The mission of Hendrick is to deliver high quality healthcare emphasizing excellence and compassion consistent with the healing ministry of Jesus Christ.

Be specific about how funds will be used including who and how many will benefit.

Has your organization previously received funds or a community grant from Hendrick Health?*

Yes

Please include the year funds were received, the amount and if the funds went toward an event or special project.*

Is there a marketing component and recognition for Hendrick Health? Please describe.*

Name of representative*

Organization*

Email Address*

Mailing Address*

City*

State*

Zip*

Daytime Phone*

Evening Phone*

W-9 and Other Supporting Documentation

Please upload your current W-9 and any other supporting documentation for your organization and for this request. Failure to do so will cause delay in the review process or request will be put on hold.

Files must be smaller than 30MB.

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