Global Health Corps

Partner Financial Assessment FY2019-2020

Thank you for your interest in becoming a Global Health Corps partner. If you would like any additional information about us at this time, you can visit our Be A Placement Organization page.
Please submit this form by 28 September 2018. Note that this form MUST be submitted by this date in order for your organization to be considered for partnership for the 2019-2020 fellowship year. 
We highly recommend that a Finance staff member from your organization fill out this form.
Please make sure to press the "Submit" at the end of the form when you are finished!
Questions? Feel free to contact us at

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Is the budget you are submitting at a multi-national organizational level or country/department level? *
Does your organization have audited financials? *

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Revenue and Expenses 
In the following sections, you will be entering information about your organization's revenue and expenses for the prior, current and next fiscal year. 

Please enter the dates for the years below.
Secured Revenue (USD)
For each row below, please provide the dollar amount of secured funding per fiscal year. Please round all amounts to the nearest whole number and mark any non-applicable fields with '0'. 
NOTE: Do not list Global Health Corps as a source of funding. * 🛈
 Prior Fiscal YearCurrent Fiscal YearNext Fiscal Year
1. Corporation
2. Foundation
3. Government
4. Individuals
5. In-Kind
6. Earned
7. Headquarters
8. Other
Please provide your total operating expenses per fiscal year below.
 Prior Fiscal YearCurrent Fiscal YearNext Fiscal Year
Personnel-Related Expenses
Other than Personnel-Related Expenses
Total Annual Operating Expenses
Current Fiscal Year Assets *
 Please round each amount to the nearest whole number.
Current Assets
    Cash and Cash Equivalents
    Account Receivables
Long Term Assets
Other Assets
Total Assets
Current Fiscal Year Liabilities and Net Assets *
 Please round each amount to the nearest whole number.
Current Liabilities
Long Term Liabilities
Other Liabilities
Unrestricted Net Assets
Temporarily Restricted Net Assets
Total Liabilities and Net Assets
I attest to the accuracy and validity of the information provided on this form. *