WISH Grant Application Eligibility, Criteria and Process Funding Availability In affiliation with the PVH and MCR Foundation, Women Investing in Strategies for Health (WISH) provides grants on an annual basis of up to $5,000 to support the programs, projects and services provided to our community through UCHealth. Funds awarded must be used in a one-year period; all funds not used within the one-year period will be returned to WISH. Application Eligibility Requirements Application reflects a direct benefit to the northern Colorado communities served by UCHealth. Application must be signed/authorized by a department director of UCHealth in the northern region. Principal Applicant is a staff member (including affiliated physicians) of UCHealth in the northern region. Co-applicant may include community partners or cooperating departments of UCHealth. For community partners working with a UCHealth department, please submit current IRS Determination Letter verifying the organization s 501(c)(3) status, including Tax ID number. WISH grants may not be used for UCHealth employee expense. If WISH funds are being sought for patient scholarships, please contact Lyndsey Hertz at Lyndsey.Hertz@uchealth.org prior to completing the application. WISH grants may not be used to purchase refreshments or catering for program events. Grant request does not exceed $5,000. Selection Criteria Application focuses on enhancement of health/healthcare needs within the communities served by UCHealth in the northern region. Preference is given to applications that support the health and healthcare needs of women, children, and families. WISH Grant Application 2019 Page 1
Application demonstrates breadth of benefit to the community. Special consideration is given to programs/projects that collaborate among departments, physicians and/or community organizations. Preference is given to programs that have not previously received WISH funding. Grant Application Process UCHealth departments, staff, affiliated physicians and/or community partners seeking to apply for WISH funds must submit a completed and signed WISH Grant Application by August 1, 2018. Applications must be signed/authorized by a department director. Grant Requests will be reviewed, and applicants will be interviewed as necessary. A slate of recommendations will be voted on by the WISH membership in November. Successful applicants will be notified in December by the WISH Steering Committee Chair and the PVH and MCR Foundation Senior Director. Recipients of WISH grants will work with the PVH and MCR Foundation representative to process related invoices for the awarded program/project/service. WISH Timeline Annual social: June Applications distributed: June 15 Annual memberships due: June 30 Grant applications due: August 1 Applicant screening and interviews: August/September Annual voting event: November Recipients notified: December Expenditure cycle: January-December WISH Grant Application 2019 Page 2
Application Information (check where appropriate) Title: 2019 WISH Grant Application Project/Program Capital equipment/ building, etc. Specify item(s): First-time Application Repeat Application (if so, describe outcomes in narrative) Principal Applicant Information: Department Name Address Email Phone Signature Co-Applicant(s) Information (if applicable): Department, Practice or *Community Partner Name of Co-applicant Address Email Phone Signature *For community partners working with a UCHealth department, please submit current IRS Determination Letter verifying the organization s 501(c)(3) status, including Tax ID number. My signature below reflects my authorization and support of this program/project. Department Director Name Department Director Signature WISH Grant Application 2019 Page 3
Respond to each of the following eight (8) questions in two (2) pages or less: 1. Provide a concise summary (1,000 words or less) of your program/project. Include what the unmet need is and how your program will address it in order to achieve the desired outcome. 2. Describe the specific outcome(s) of your project/program. And how will you measure its success? 3. Provide the projected number and demographics of those who will benefit, both directly and indirectly. 4. Are there other departments/programs that provide similar services? How are your services unique? How do you avoid duplication of services? Be as specific as possible. 5. Demonstrate your collaboration with other departments, physicians and/or community organizations. 6. If the total project budget exceeds the amount requested, what are your plans for additional funding? (e.g. Describe additional financial support you are applying for, or have been awarded, specific to this request.) 7. If this is a pilot project, what are your plans for sustaining project funding in the future? 8. If request is denied, what are your alternate plans for funding? WISH Grant Application 2019 Page 4
WISH Project Budget Information (attach additional pages if needed) Equipment/Capital Description $ Timeline for Use of Funds if Granted Services/Supplies Other - please specify (e.g. supplies for participants) Total Project Costs $ Notes: WISH Request $ Notes: Anticipated Other Funding $ Provided by: Funding shall not include food/catering or UCHealth employee expense Submit completed application (electronic version acceptable as long as signatures are affixed) by August 1, 2018 to: PVH and MCR Foundation 2315 E. Harmony, Suite. 200 Ft. Collins, CO 80528 Lyndsey.Hertz@uchealth.org 970.237.7408 WISH Grant Application 2019 Page 5