If Outside of YRMC:

Mailing Address:
Contact Name:

Download form here.

Max. file size: 50 MB.
Please feel free to adapt the income and expense line items to fit your project. If you need to provide additional information, you may do so.

Provide a detailed summary of your program/project

Please include:
  • Patient and or family/community needs that will be addressed
  • Desired outcomes
  • How you will measure success and report goals
  • Population demographic served
  • How this project/program enhances, improves the well-being of Yuma County oncology patients

Define how your project/program will serve identified vulnerable or underserved populations to help address health disparities

Is this a single year or multi-year project:*
List the evaluation processes or methods you will use to measure progress in order to determine the degree in which you met intended output(s):*
Column 1
Column 2
Column 3
 
Can you provide implemented supporting evaluation method documents, if requested?*
Is this grant request to support oncology related equipment?*