Department Grants Application

APPLICATION are due in the Miami Valley Hospital Foundation office by the last day the following months: March, June, September, and December. MVH Foundation’s offices are on the first floor of the main hospital across from the main elevators.

The Department Grants Committee will give priority to grant applications that meet the following qualifications:

Advancement of quality patient care and/or
Improvement in the atmosphere or working conditions of Miami Valley Hospital employees and/or volunteers.

Proposed Project Title: *

Amount Requested: * $

(Department Grant limit: $2,000.)

Sponsoring Employee: *

Phone Ext.:

Department: *

Dept. Number:

Please provide a brief description of the proposed project, including the need: *

Note how proposed project meets Department Grants qualifications.

Has the proposed project been submitted through your department's budget? Outcome?: *

Will other departments/employees benefit or be affected by this request? If so, please explain.: *

Please provide an itemized list of the dollar amount and corresponding item(s)/service(s) for the amount requested.: *

Is additional funding required? If yes, how do you plan to obtain?:

Has this project been implemented before? If yes, explain details.: *

Does the proposed project require ongoing funding? If yes, explain source of future funding.: *

Signature:

Leave blank - to be signed after printing

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