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Lake Charles Memorial Health

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Foundation for Fairplay Grant Application


The Foundation for Fairplay fund was established to provide a more level playing field in the areas of preventable injury needs such as acquiring quality football helmets, placement of training room equipment needed for the rehabilitation of sports-related injuries, safe physical fitness surroundings, etc.

Please fill out the form below.

Email the requested materials to lpedersen@lcmh.com or mail to: The Foundation at LCMH, 1701 Oak Park Boulevard, Lake Charles, LA 70601.

If you have any questions, call the Foundation office at (337) 494-3226.


 

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First Name
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Last Name
*
Email
*
Telephone
*
Address1
Address2
*
City
*
State
select
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Zip
  
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School Name
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School Address
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Athletic Director Name
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Principal Name
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School Board Representative Name
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Sport grant is requested for
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Executive Summary:
Provide a descriptive summary of the need these funds will help alleviate – injury prevention should be highlighted.
If you need more space, include in emailed or mailed materials.
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Amount Requested:
Email or mail a written, itemized proposal from vendor(s).
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Funding requested:
Provide a detailed listing showing (a) vendors quote; (b) age of current items being used (if applicable); (c)  when funds are needed for payment; (d) length of time items will be expected to last.
If you need more space, include in emailed or mailed materials.
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Athletic budget:
Email or mail school’s most recent budget for athletics program.
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Boosters statement:
Email or mail the previous two years financial statement for Booster organization.
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Tax Status:
Email or mail a copy of the most recent 501 (c) 3 letter of determination of tax exempt status issued to the school by the Internal Revenue Service.
SUBMIT
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Lake Charles Memorial Health System
1701 Oak Park Boulevard
Lake Charles, LA 70601
(337) 494-3000
Physicians & Employees Only