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McDaniel's Grant Application

Foundation of Yuma Regional Medical Center
Richard Michael McDaniel Endowment Fund Grant Application

* Indicates required information
Full Legal Organization Name: * 
Street Address: * 
City: * 
State: * 
Zip: * 
Organization Website: * 
Organization President / Executive Director: * 
Title: * 
Phone Number: * 
E-Mail Address: * 
Contact Person (If different): 
Phone Number: 
Email Address: 
Is your agency tax exempt under section 501(c)(3)?: * 
Year Established: 
If not, do you have a fiscal agent?: * 
Fiscal agent name: 
Fiscal agent address: 
Total Organization Budget: * 
Total Number of Board Members: * 
Total Number of Staff: * 
Total Number of Volunteers: * 
Organizational Mission Statement (350 characters or less): * 
Brief Description of Organization (500 characters or less): * 
Population Served (200 characters or less, include age groups, race & ethnicity, income leves, etc.): * 
Program / Project Name: * 
Total Program Budget: * 
Requested Amount: * 
Type of Request: * 
Geographic Area Served: * 
Priority funding areas of grant maker's (indicate how your request fits within the grant maker's strategic interest[s]): * 
Please provide a brief summary of your request (3 sentence or less): * 
Description of current programs and activities. Please emphasize major achievements of the past two years: * 
Describe the overall goal of the grant proposed: 
Describe the measurable objectives of the grant: 
Explain how you will measure the effectiveness of your activities: 
Describe the results you expect to have achieved by the end of the one year funding period: 
Proposed Program Budget: 
Authentication * 

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