close

Our Health Library section is currently undergoing maintenance. We apologize for the inconvenience.

Find It Fast!

Go

Search Our Site

Go

My Health Tools

Go

Lake Charles Memorial Health

page graphic
  • Text Size

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.


 

*
First Name
*
Last Name
*
Email
*
Telephone
*
Address1
Address2
*
City
*
State
select
*
Zip
  
*
School Name
*
School Address
*
Athletic Director Name
*
Principal Name
*
School Board Representative Name
*
Sport grant is requested for
*
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.
*
Amount Requested:
Email or mail a written, itemized proposal from vendor(s).
*
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.
*
Athletic budget:
Email or mail school’s most recent budget for athletics program.
*
Boosters statement:
Email or mail the previous two years financial statement for Booster organization.
*
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.
layout graphic
© Copyright 2014 Lake Charles Memorial Health System. All Rights Reserved.Pencil

Home | Contact Us | Site Map | Terms of Use | Website Feedback | Directions | HIPAA

Everything Your Healthcare Should Be
Lake Charles Memorial Health System
1701 Oak Park Boulevard
Lake Charles, LA 70601
(337) 494-3000
Physicians & Employees Only