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Application

Overview

The Bolivar Medical Center Foundation’s Mission is to improve the quality of health care provided to the citizens of Bolivar County and to provide instruction to the public on the improvement of personal health, hygiene and safety. 

To fulfil this mission, the Foundation disburses funds to worthy organizations which present projects and programs of work which are relevant to the Foundation’s healthcare driven focus.

Thank you for taking the time to review the grant application procedures. Please carefully read the “Frequently Asked Questions” and instructions listed below so that you may better understand both the Foundation and the process for applying for grant funds from the Foundation.


Instructions

Please provide the requested information about your organization on the application. To submit your application, you are also required to enclose the following appendices with your application: 

  • Appendix A: Itemized projected budget for this project.
  • Appendix B: Your organization's current annual operating budget, including salaries, in-kind services and volunteer hours.
  • Appendix C: Current board of directors, listing occupations and business addresses.
  • Appendix D: Supporting documentation, if any.
  • Appendix E: 501(c) 3 letter or legal opinion certifying that the applicant is a public charity as described in section 509(a)(1), (2) or (3), or that the applicant is covered by section 170(c)(1) of the Internal Revenue Code. Only those applicants meeting this criteria will be considered. 

You must submit the original and ten (10) additional copies of the completed form and all supporting documentation for a total of eleven (11) copies. Mail the packets with a total of eleven (11) applications with any supporting documentation to:

Allocations Committee
Bolivar Medical Center Foundation
PO Drawer 298, Cleveland, MS 38732

All applications and supporting documentation must be postmarked no later than May 1st. Applications postmarked after May 1st and incomplete applications will not be considered. The application must include all signatures and appendices.

On behalf of the Bolivar Medical Center Foundation, Inc. please know that we are happy for your interest and wish you much success in your efforts as you continue to fulfill your mission. Award notifications will be mailed on or before May 1st. If you have any questions, please contact:

Jamie Jacks
(662) 843-6171
jjacks@jlpalaw.com


Application

Please click the link below to download the application form to be added to all required appendices upon completion.