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: *

One time

New ongoing

Annual Renewal

Are you the traveler requesting funds?

If no, provide the name of the traveler.

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

Please describe the equipment / project / program (attach copies of invoices, brochures, catalogs, etc.). Please include applicable information to support the requests such as: the impact of the request, the planned results, support funding for equipment, numbers served, impact on core measures and/or safety goals. *

Who is the Vendor?

Proposed purchase date +

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 equipment/request not included in the current budget? *

What are the maintenance plan and life expectancy for the equipment/request? *

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

Please upload any documents (quotes, receipts, 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 * +