McKee Foundation Funds Request

Date of request * +

Needed by date * +

Amount of request *

Department

+-

Contact Name *

Contact's Email *

Phone Number * 🛈

What type of request is this: *

Program or equipment

Continuing education

Staff medical, dental, or mental health hardship

Are you the fund recipient?

If no, provide the name of the recipient

Is this request also being submitted to the Volunteer Service League? *

Please describe the request (attach copies of invoices or support documents). Please include applicable information to support the requests such as: the need, the impact of the request, and the number of individuals served. *

Name of vendor(s)

Date needed +

Please indicate the impact: *

Improved staff experience

Improved patient experience

Patient or staff safety

Have you asked Banner for support of this request: *

Yes

No

If yes: why was it not funded? If no: why not? *

Why is this not included in the current budget? *

What is the impact if this request is not approved? *

Please upload any documents (bills, quotes, etc.) to support your request.

For Banner Health Systems Departments: your request must be reviewed and approved administrative team. If your request has not been reviewed by the administrative team please discuss your need with leadership prior to applying. Who approved your request? *

Manager or Directors Signature. I certify that all information is accurate and my request has been approved by the McKee or BFCMC leadership teams. *

clear

Date * +