Hospice Promise Foundation Educational Grant

Date*

Applicant's Name*

First Last

Title*

Agency Name*

Agency Address*

City State / Province / Region

The Hospice Promise Foundation Educational Grants include:

A. Professional Development Grants

Awarded for professional development events such as conferences, programs, continuing education classes, etc.
Maximum grant is $1,000 per year.
The recipient will be given provisional approval for the grant and will be reimbursed once the individual provides proof of attendance (via CEU certificates, etc.).

B. Certification Grants

Awarded for Hospice and Palliative certification.
Maximum grant is $750.
The recipient will be given provisional approval for the grant and will be reimbursed once the individual provides receipts for all expenses and proof of certification.

C. Academic Scholarship Grants

Awarded for classes at an accredited academic institution that relates to community health. For example, an aide, RN, social worker, chaplain, or volunteer coordinator advancement education.
Maximum grant is $2,500 per academic semester.
The recipient will be given provisional approval for the grant which will be reimbursed once transcripts of grades for courses are submitted (at least a C for undergraduate and B for graduate).

D. Community Development Grants

Awarded for special hospice events/projects that will impact/influence a community (local, regional, and state) related to end-of-life.
Maximum award $1,500 per year.

*Applicants with financial hardships may request payment in advance if certain criteria are met. Please inquire if you believe you may qualify.

I would like to apply for Education Grant Category...*

A. Professional Development Grants
B. Certification Grants
C. Academic Scholarship Grants
D. Community Development Grants

Category/Explanation of requested grant (Please include as much information as possible, such as: name and agenda of conference, CE class information, type of certification, academic focus, community development project, etc.):*

Please include an estimated list of expenses for this activity:*

Explanation of how the special event/education will promote hospice and palliative education/knowledge at your agency and in your community. What value/impact will be gained or expected? Please attach additional documentation if needed.*

Employee Requirements: Place a check mark by each of the listed criteria and be sure to include any supporting documentation with the application.*

Full-time employee in good standing for at least one year
Attached recommendation letter from current supervisor
Up-to-date on all orientation and training requirements
No current disciplinary action

A letter for good standing from your supervisor must be filled out and submitted with this form. Download Letter of Good Standing Letter Example

Expected date of completion:*

Upload Documents*

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Acknowledgement*

I attest that the information provided in my application for a Hospice Promise Foundation educational/community event grant will be used to further my expertise and knowledge in the provision of hospice care or will benefit the community in hospice awareness.