MultiCare Community Partnership Fund Application

If you have any questions, please contact the MultiCare Community Partnership Fund at communityfund@multicare.org.

You can save your application at any point to continue at a later time using the Save button at the bottom of this page.

Organization Name *

Organization shown on 501(c)3 letter *

Tax ID# *

Contact Person and Title *

Street Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Is the mailing address the same?

Yes

Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Contact Person Email *

example@example.com

Organization Website Link *

Name and Title of Executive Director or President *

Executive Director or President Direct Email *

Different from Contact email – needed for funding notification

Geographic Area to be Served *

Project Title *

Client Group to be Served *

Size of Group *

Anticipated Project Period (Ex: Date Range: mm/dd/yyyy to mm/dd/yyyy) *

Type of Request *

Special Project Operations / Program

Requested Amount? *

Is there someone from MultiCare Health System currently involved with your organization as a volunteer, Board or Committee member? *

Yes No

If Yes, who is it?

Purpose (What will this project or program specifically accomplish? What community need will this address?) *

Relevance (Why should MultiCare support this effort? How does the project align with MultiCare’s mission?) *

Our Funds (Specifically, how will this grant be used?) *

How do you propose MultiCare be involved in this project beyond funding? *

Approach (How do you plan to implement this project or program?) *

Coordination (Who else in your community is working on this need? How will you coordinate with them?) *

Evaluation (How will you determine that the project is successful and is meeting its goals?) *

Anything else (What else would you like us to know?)

Describe other ways in which you could partner with MultiCare to improve the health of our community? *

Please include a 100-word bio of your organization (for publication on multicare.org) below. *

0/100

Please upload your organization's current IRS Form 990 (not older than 2019 for the current 2021 funding year). If your organization has tax-exempt status, please upload your current IRS Form 990 e-postcard with the application.

Upload your IRS Form 990 *

Browse Files

File types include pdf, doc, docx, jpg, jpeg, png, etc.

Submit your application

You should receive an email confirmation of your submission sent to the email address on the application. A copy of your application should be included with that email. Please check your spam folder as these can often be found there. If you do not receive this email, please contact communityfund@multicare.org. Thank you.

MultiCare Community Partnership Fund Application - Puget Sound Region