Grant Application

Summerland Health Care Auxiliary

Diagnostic, treatment or residential care services as provided in the Penticton Regional Hospital, Summerland Memorial Health Centre or the Dr. Andrew Pavilion Extended Care Unit.
Treatment pertaining to a specific medical diagnosis as provided by a non-profit institution or community based non-profit organization.
Research pertaining to innovative treatment methods for a specific medical diagnosis.
Education pertaining to undergraduate, post-secondary career paths in health care or related fields of study.

Organization Name

Contact Person

Phone Number

Email Address

Date Filled Out

Non-profit Organization?

Yes No

Registered Charity?

Yes No

CRA #:

Amount Requested:

Deadline Date for Funding Notification

How will the grant be used? (Briefly describe what you are asking for. Max 200 words.)

How does the program align with SHCA's mandate for grant funding? (Max 200 words.)

What municipality(ies) would be serviced by this grant?

Target audience:

Please provide a brief overview of your organization: (Max 200 words.)

Other potential funding sources:

How will you measure anticipated results/outcomes? (Max 200 words.)

How will the funding be acknowledged?

Application submission date:

Signed: