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Applications

Grant Application Guidelines

Grant Application

Grant Report Form
Scholarship Application Guidelines

Scholarship Application


Burbank HealthCare FoundationGrant Application Guidelines

Deadline November 15, 2016

The Burbank HealthCare Foundation serves the Burbank community through grant making in an effort to improve the quality of health care and meet community health care needs. Both the law and our internal policies place limits on our grant making.

We only fund organizations that:

qualify under Section 501(c)(3) of the Internal Revenue Code; and
are located within the Burbank community or for use within Burbank.

We give preference to applicants that plan to use Burbank Health Care Foundation funds as matching grants.

We do not provide grants:

to individuals;
for political purposes;
for any purpose that discriminates as to race, creed or ethnic group; or
for endowment funds.

Application Procedures

Our Grants Committee thoughtfully considers each grant application and its recommendations are presented to the Board of Trustees for final decision. Grant applications and all back-up materials should be submitted as early as possible and post-marked no later than 5:00 p.m., November 15th.

Additional Information Required

Grant applications should be completed as outlined in the application with any additional information deemed necessary attached to the application. The application should include all of the information requested as follows in addition to that requested in the application:

1. Sources from which funds are presently being sought for the proposed project, or sources from which such solicitation is contemplated. (We encourage participation from other sources in supporting projects we fund.)
2. A statement describing any known relationship with the Burbank HealthCare Foundation, such as common directors, trustees, officers or contributors.
3. A copy of the most recent letter or letters from the Internal Revenue Service stating that the applicant organization is qualified under IRC Section 501(c)(3), and that the applicant is not a private foundation or is an exempt operating foundation.
4. A letter signed by a responsible officer or other responsible employee of the applicant stating that the Internal Revenue Service letters described above remain in effect and have not been revoked, and that the applicant's current operations and sources of support are not inconsistent with the tax status set out in such letters.
5. A copy of applicant's most recent IRS Form 990.
6. Financial statements from applicant's most recent year-end, including audited statements, if available.
7. Any other information applicant considers pertinent to the application.

Follow-up for Successful Applicants

Organizations that receive a grant from the Burbank HealthCare Foundation are required to:

Sign a Grant Agreement;
Submit a receipt of funds immediately upon receipt of funds;
Plan to send an organizational representative to attend the Foundation Awards Dinner in the Spring as a guest of the Foundation;
Submit (2) semi-annual detailed reports on how the funds are expended. The first report will cover the reporting period ending June 30. It should be submitted as soon after the reporting period as possible and no later than October 1 of the same year. The second report will cover the reporting period ending December 31. It should be submitted as soon after the reporting period as possible and no later than April 1 of the following year. The final report should include an evaluation or measurement of the impact of the grant.
  Note that organizations that do not properly complete the reporting for a grant which they have received may be disqualified for future funding. Also, organizations that were previously awarded grants may have their awards cancelled or postponed in portion or in their entirety if they fail to properly complete the required periodic reports.


Burbank HealthCare FoundationGrant Application

For your convenience, the Grant Application can be printed
as a blank pdf form or you may complete online and print.

Be sure to submit a printed application form with all attachments.


Grant Report Form

First reporting period ends June 30. Report due October 1.
Second reporting period ends December 31. Report due April 1.

Every organization that receives a grant from Burbank HealthCare Foundation is required to file semi-annual reports with the Foundation relative to the status of their grant. Any organization that fails to file the required reports, or who files improper or untimely reports, may not be eligible to receive future grants.

Those awarded grants may have their awards cancelled or postponed in portion or in their entirety if they fail to properly complete and submit the periodic reports.

Please complete this form online or print, complete, and submit by mail to the Burbank HealthCare Foundation. The first reporting period ends June 30. The second reporting period ends December 31. Please submit a report within 90 days of the end of each reporting period.

Feel free to attach additional materials such as a brochure or a letter but note that attachments are not to be considered a substitute for this form.

For your convenience, the Grant Report Form can be printed as a blank pdf form and submitted by fax or mail
or you may complete and submit online.


Burbank HealthCare FoundationScholarship Application Guidelines

Deadline December 30, 2016


The Burbank HealthCare Foundation offers educational scholarships to students who are enrolled in, or will be enrolled in, an accredited school of medicine, dentistry, nursing, pharmacy, optometry or allied health. (Qualifying allied health specialties include: emergency medical technician-paramedic; medical assistant; perfusionist; polysomnographic technologist, respiratory therapist, surgical assistant, surgical technologist, physical therapist, occupational therapist, speech therapist, radiology technician, and laboratory technician.)

To apply, complete this form and submit it to Burbank HealthCare Foundation, along with two letters of recommendation and a one page essay describing how you intend to contribute to the excellence of health care in the greater Burbank community upon completion of your studies and clinical requirements. The application submission deadline is December 31, 2016. Scholarships of up to $10,000 will be made on an annual basis, and recipients who maintain a grade point average of 3.2 or greater will be eligible to apply for renewal of their grant for up to three years. Awards notifications are made in the Spring.


Scholarship Application

For your convenience, the Scholarship Application can be printed as a blank pdf form or you may complete online and print.

Be sure to submit a printed application form with all attachments.