Foundation/Donations: Request For Funds Application

The Upland Hills Health Foundation, Inc. has established a process to allow staff members to submit applications for funding to support projects/items at Upland Hills Health. The Upland Hills Health Foundation will accept applications four times a year. The applications will be due by 4:00 p.m. on the last Monday in the months of January, April, July, and October. The members of the Project Development Committee will review all applications. The Foundation recommends that anyone submitting an application check with the Foundation Director prior to developing/submitting an application to determine the availability of funding. The Foundation will fund up to 50 percent of any project. The Board will consider all funding applications and has the discretion to approve the total, a partial or none of the funding request. Successful applications will be asked to provide the Foundation Board of Directors with a brief program or demonstration of the impact of the funding opportunity. Please contact the Foundation Director at ext. 4851 with any questions.

Proposed Project/Item to be Funded:

Date of Application:

Amount of Request:

Amount of Shipping: (if not included in request of funds above)

Name of Person Submitting Application:

Department Contact Number:

Contact E-mail:

Indicate which Strategic Plan Item is impacted by your proposed funding item.
Respond to as many strategic items that apply.

Clinical Excellence
(Desired End State - A cohesive team of clinical staff providing high-quality patient care in a safe environment.)
Customer Service
(Desired End State – Provide the ideal “five star hotel” experience to all customers/guests.)
People
(Desired End State – Providing a premier workplace.)
Growth
(Desired End State – Increase market share and decrease out migration.)
Finance
(Desired End State – Provide strong community benefit while maintaining positive operating margin.)

Each selected Strategic Plan item must have an explanation of how the desired end state will be achieved.
A score of 1-5 will be awarded for each response. Only proposals with selected strategic items and supporting statements will be accepted.

Clinical Excellence Statement:


Customer Service Statement:


People Statement:


Growth Statement:


Finance Statement:

Explain how the proposed funded item will impact the Mission of Upland Hills Health

Is this request anticipated as a one-time request for funds? Yes    No

If no, how often do you anticipate requesting additional funds?

An e-mail statement from your direct supervisor must be attached to your application.
The supervisor must provide a brief statement regarding the impact of this funding.

Each application must also include attached documentation of proposed item.
(brochures, print out from website, copies of item from catalogs, or some other visual to assist the Board Members in better understanding the proposed project).
Please limit supporting documentation to no more than 4 sheets of paper.