The Ferrell Duncan Clinic Foundation Not-For-Profit Grant Application

Grants provided through the Ferrell-Duncan Clinic Foundation Fund.

To apply for a Ferrell Duncan Clinic Foundation Community Not For Profit Grant you must be a 501c3 not for profit organization that provides services in our Southwest Missouri region. Applications will be accepted each quarter for review with deadlines being March 1, June1, September 1 and December 1.

Complete the application, provide your sponsorship proposal and a W9 along with proof of your not for profit status.

Questions? Contact the CoxHealth Foundation at 417-269-7150.

A W9 form is also required for payment of sponsorship. Please include with your submission so it will not delay payment if approved. All applicants will be notified of the outcome of the submission requested.

Ferrell-Duncan Clinic Foundation Not-for-Profit Grant Application

"*" indicates required fields

X/Twitter

This field is for validation purposes and should be left unchanged.

Organization Name

Name of Contact Person*

Email*

Phone Number/Extension*

Address

Street Address City State / Province / Region ZIP / Postal Code

Organization Information

Who does your organization serve?*

How many annually, does your organization serve?*

Do your fundraising dollars remain in SW MO?

Yes

If so, what percentage?

Fundraiser Details

Name of Fundraiser

Location of Fundraiser

Date of Fundraiser

Expected Attendance:

When are funds needed?*

Requested Amount (Please include the proposal by uploading it below with this form submission.

What benefits will be received for the sponsorship as far as tickets/advertising/media, etc?*

What will your event benefit within your organization - administration, special project, equipment, etc?*

Upload any files pertinent to your request.

Max. file size: 2 GB.