Mollison Continuing Education Grant Application

The Sr. Mary J. Mollison Endowment provides grant funding to support continuing education opportunities for HaysMed Associates.

Application Guidelines

Applications for grants may be submitted through the form on this page.
All grant requests submitted will require a detailed budget of funds requested.
The Mollison Fund Committee will consider applications as they are received.
Applicants will receive email notification of the committee’s decision.
Please submit grant requests a minimum of 6 weeks prior to your continuing education event. If this is not possible, please contact the Foundation directly prior to submitting a request.
Grant recipients must submit a written report to the HaysMed Foundation within a month of attending the grant funded educational opportunity. The report must include a synopsis of what was covered at the conference, issues learned by the attendee(s) and how the knowledge gained will provide benefit our Associates, patients, and/or processes.

Funding Procedures

Grant request may be for the cost of conference/event registration OR travel expenses (meals, lodging, mileage, airfare, etc.), whichever is greater.
- Remaining expenses may be covered by the department or by a personal investment from the requesting Associate.
Grants shall be used solely for the requested purpose.
Grant funds will be expended upon proper documentation from grantee. Itemized receipts must accompany all requests for reimbursement.
Recognition of project funding by the Mollison Fund at the HaysMed Foundation must be included in all media and program materials when applicable.

Continuing Education Grant Application

If you would like to save your progress and continue at a later time, please use the Save and Continue Later link at the bottom of the form. A unique and secure link will be provided to you which you may use for up to 30 days to view your progress and continue working.

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Eligibility
The Sr. Mary J. Mollison Endowment provides grant funding to support continuing education opportunities for HaysMed Associates.
HaysMed Associate Verification*
- The recipient of the grant is a HaysMed Associate
Recipient's Department/Area*
Recipient's Associate Title/Position*
Has recipient applied for a continuing education grant from the HaysMed Foundation?*
- Yes
- No
- Not Sure
Has recipient ever been awarded a continuing education grant from the HaysMed Foundation?*
- Yes
- No
- Not Sure
Name of Person Completing this Form (if other than applicant)
Applicant(s) Name*
If applying on behalf of multiple Associates, list all names here.
Applicant(s) Department/Area*
Your Email Address*
Enter address of primary contact for request.
Your Phone Number*
Enter number where primary contact can be reached during business hours.
Director's Approval Confirmation*
Applicant's Director must approve request prior to committee review. Please include the Director's or Vice-President's name.
Director has approved this educational opportunity*
- Yes
Continuing Education Program Information
Title of CE Opportunity*
Date of Program/Conference*
Location of Program/Conference*
Amount Requested
Grant funding will support either travel expenses OR registration fees.
Please enter a number from 1 to 10000.
Documented Need for this Education*
Specific Goals and Objectives*
How Will This Education Benefit HaysMed*
Timetable for Completion*
Process for Evaluation*
Other Sources of Funding*
Include expected amounts and restrictions for use.
How HaysMed Foundation Funds will be Utilized*
Complete Budget Estimate*
Include any additional information of which you would like the committee to be aware.
Additional Documentation
Attach program brochures and/or information. Only files in PDF format will be accepted.
Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 3.

The Sr. Mary J. Mollison Endowment provides grant funding to support continuing education opportunities for HaysMed Associates.

Continuing Education Grant Application

Eligibility

Continuing Education Program Information