2025 Community Health Grant Application

2025 Community Health Grant Application
The Skyline Health Foundation's mission is to support, enhance, and expand the activities of Skyline Hospital and improve the health and well-being of all the people it serves.

The Foundation awards grants to local non-profit organizations that work to improve the health and well-being of the community.

Criteria To Apply
- 501c3 non-profit organizations with tax-exempt status that are not a religious, political, or governmental organization, and are not applying for an event that is a fundraiser.
- Located within the Skyline Health Service Area, which includes Klickitat County Hospital District No. 2, Eastern Skamania County, Hood River County, and Mosier.
Requirements If Awarded
- Provide a copy of the organization’s tax-exempt status.
- Implement the project within a year of the award.
- Complete a brief Impact Form provided by the Foundation six months after implementation of the project.
- *Organizations unable to complete the project will be required to return the funding to the Foundation.
Application Process
- Grants are awarded on a rolling basis each month until the funding distribution for the year is complete.
- The Foundation Board of Directors Grants Review Committee will evaluate all proposals and make final recommendations for grant awards at their monthly meeting.
- All applicants will be notified of the final status of their proposals via email.
Award Amount
The total available for distribution in 2025 is $20,000 for the year.

Contact
For questions regarding your grant application or award, please contact Elizabeth Vaivoda at evaivoda@myskylinehealth.org or 509-637-2602.
ORGANIZATION
Organization Name*
Organization Website*
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Project Contact *

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
E-Mail Address*
example@example.com

Organization Information
501(c)(3)?*

YesNo
Year Established*
Is this a request for a religious, political, or governmental organization, or an event?*

YesNo
Board of Directors: Please include their names, positions, and a phone number or email address.*
Describe the mission, vision, and values of the organization. *
Describe in detail the demographics of the key populations served.*

Proposal Request
Program / Project Name*
Total Program Budget*
Requested Amount*
Project Overview*
Demonstrate the need for this project. *
Describe in detail the demographics of the populations who will be served by this project.*
What are the expected outcomes? *
How does this project fulfill your mission and align with your values? *
How does this project fulfill Skyline Health Foundation's mission to improve the health and well-being of the community?*
Are any organizations collaborating with you on this project?*

YesNo
If yes, who are they, where are they located, and what is their role?

Financial
Describe in detail the distribution of the funding requested.*
If applicable, outline any in-kind support to execute the project.
Are there additional funding sources for this project?*

YesNoMaybe
If yes or maybe, what are they and how much are they contributing?
Signature
Person submitting the grant*

First NameLast Name
By signing the space below, you are certifying that all information is correct, that you are the person completing this application, and the Skyline Health Foundation is authorized to contact parties named to verify all information submitted.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature*

Powered by Jotform SignClear
Date Submitted*

MonthDayYear
Date
Should be Empty:

2025 Community Health Grant Application

ORGANIZATION

Organization Information

Proposal Request

Financial

Signature