The Generosity Works program at Providence Regional invites departments to apply for grants twice a year for programs, equipment or initiatives that impact patient care. Applications can be up to $10,000 per project or initiative and are evaluated by the Generosity Works Steering Committee based on impact to patient care, sustainability, and availability of funds. Once applications are evaluated, the Committee makes a recommendation to the Providence General Foundation Board of Directors for final award approval. Grants must be used within six months, and evaluation of the program or capital expenditure is required one year after the initial approval of the grant.

GenerosityWorks

EligibilityAny department or program within the Providence Northwest Washington Region—Providence Regional Medical Center Everett & Providence Medical Group—is eligible to apply for grants. The contact or champion of a grant can be a hospital employee, contractor, physician on active medical staff or volunteer operating under the authority of a department manager/director.

Criteria for FundingGrant requests can be for either programs or for capital equipment, up to $10,000.

Program grants support new programs or expansion of existing programs that impact patients or families at Providence (i.e. operating expenses, education, etc.). Capital Support is defined as any item with a useful life of more than two years and has a cost of $2,500 (includes tax, shipping, installation) or more.

Capital Grants support the construction, purchase or renovation of facilities and/or the purchase of equipment to be used by departments. Requests that involve capital will require approval from the Vice President, and separate capital request form will need to be completed.

Generosity Works requests should be for projects that support the mission and work of Providence and enhance the quality of healthcare services for patients and families served by our ministry.

Grants generally do not fund:• Hourly or salaried positions• Information technology• Organizations or initiatives outside our ministry.

DeadlineApplications for the spring grant cycle must be received by April 15. The fall grant cycle deadline is October 15.

Awarding GrantsThe amount of dollars available for each grant cycle will be determined by the Generosity Works Committee based on the number of grant requests, quality of requests received, and the availability of monies. Once approval is obtained, all programmatic operating expenses are to be initially incurred by the requesting department’s cost center. When the implementation is complete, funding will be transferred from the Foundation to the department’s cost center as a reimbursement. Funding for Capital follows the capital expenditure process.

GenerosityWorks Application Apply online at ProvidenceGeneralFoundation.org

Contact: Title:

Department: Cost Center #:

Phone: Manager:

Project Name or Item:

Amount Requested (<$10k): Date:

This is a capital request (a capital request form must accompany application)

This is a programmatic grant, not capital

Please provide a brief description of the item or program for which you are requesting funding.

Why is this program needed?

What are the benefits expected from this improvement?

Who will be impacted by the project (specify short and long-term impact)?

What are the implications if this request goes unfunded?

How is your request in line with the strategic plan for our ministry?

Are there other departments or organizations collaborating on this project? Please specify.

What measurement(s) would you hope to provide in one year to demonstrate success?

How has your department assisted the Foundation in fundraising in the past year? (i.e. participation in Employee Campaign, support of Foundation events through auction donations or volunteering, etc.)

Need more room? You may include extra attachments with your application.

Apply online at ProvidenceGeneralFoundation.org Return your completed form to Providence General Foundation, 916 Pacific Ave, Everett WA 98201.

For more information, visit our website at ProvidenceGeneralFoundation.org or call (425) 258-7500.

BudgetList all expenses or capital (itemized) related to this request (include incidentals and provide estimates):

Expense/Capital Amount (s)

$

$

$

$

$

$

$

$

$

$

Tax $

Shipping & Handling $

Other incidentals (installation, etc.) $

Need more room? Include an attachment. Total $

My request is for a capital project, and the signed capital request is attached.

Yes No Was this program included in your fiscal budget?

Yes No Are you aware of any grants that might be available for a project like this?

Yes No Have you previously received funding or approval for this project?

Yes No Has this department received any funding from the Foundation in the past?

If so, for what? _______________________________________________________________________

Required SignaturesI affirm that I have read and understand the guidelines for the Generosity Works program. I understand that I will be responsible for implementing my project within six months of grant approval and for completing the grant evaluation form within one year of the grant implementation.

Applicant/Primary Contact Date

Department Manager /Director Date

Department Vice President Date