APPLICATION FOR FINANCIAL ... - CAMC Health System - camc 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Your Organization and Tax ID #' in the designated field. Ensure accuracy as this information is crucial for processing your application.
3. Fill in your organization's 'Address' and provide a 'Contact Person / Title' along with their 'Phone and e-mail address' for communication purposes.
4. Describe your organization's mission succinctly in the 'Mission of Your Organization' section, highlighting its core values and objectives.
5. In the 'Service Area and Population Served', specify the demographics and regions that benefit from your services.
6. List the 'Primary Services Offered' by your organization, ensuring to cover all key areas of assistance provided.
7. Indicate the 'Amount of Funding Requested' clearly, followed by a detailed 'Description of Your Funding Request'.
8. Complete the section on other sources of income or funding, detailing any additional financial support received.
9. Answer questions regarding administrative funding usage, public acknowledgment of CAMC’s contribution, and nonprofit status accurately.
10. Finally, check applicable priority health needs that your request supports and attach any additional information or letters of reference that may assist in consideration.

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