Top Left Corner Top Right Corner
Yuma Regional Medical Center
Pad Lock
Before TopNav
Left Side

Left Nav Bottom

Decrease (-) Restore Default Increase (+) font size

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: *