Sample Application Overview

Mount Zion Campus-based Awards: The following information is required to complete your online application. This page is for planning purposes only. All new requests must be submitted online here or renewal requests, here.

Name(s) Date
Title Phone(s)
Division/Dept. Email
Mailing Address Alternate Contact(s) for content questions about this application
Name and email for Mount Zion Program Head (e.g., Chief of Service, Center Director, Division Chief, or Department Chair), to be contacted to verify that the proposed project is an MZ Campus-based activity, led primarily by MZ Campus-based faculty, staff and/or trainees, that will especially benefit MZ Campus constituents (e.g., patients and/or families, faculty, staff and/or trainees)
Project Title Anticipated Project Start Date and End Date
Total Project Budget Total Amount Requested from MZHF
Executive Summary (in 1-3 sentences state the main goal(s) of the requested funding; also include a paragraph summary of the project):
  1. Explicitly benefits underserved communities. Describe the project and its purpose, including the unmet health need, target population, and the estimated unduplicated numbers to be served (explicitly state how the project advances the health of one or more underserved populations who have limited access to quality health services because of inability to pay, health status, race, religion, language, gender identity, or sexual orientation).
  2. Based at or in partnership with the UCSF Mount Zion Campus, or shares Jewish roots. State whether the project is based at UCSF Mount Zion Campus, and describe how the project enhances care and/or health education for UCSF Mount Zion (and beyond).
  3. Embodies one or more of MZHF’s core Jewish Values. Articulate how the project embodies one or more of MZHF’s core values.
  4. Addresses a compelling San Francisco or UCSF Mount Zion health priority. Explain the compelling UCSF Mount Zion health priority the project addresses, and list the specific goals (measurable outcomes) for the project numerically in order of priority. For each of the goals listed, provide a brief evaluation plan for collection of information (for example, using data from a patient survey or from metrics such as number of patients served) to facilitate MZHF’s assessment of your success in meeting project goals. To receive funding, the proposal must include a plan for evaluation with measures of both quantitative and qualitative outcomes.
  5. Potential impact of the project is significant. Describe the significant potential impact of the project.
  6. Team can successfully complete the project on time/budget. Provide a list of key project staff with qualifications, and a project timeline documenting plans to successfully complete the project on time/budget.
  7. Applicant can articulate plan for financial sustainability of project beyond the grant period. Articulate the plan for financial sustainability of the project beyond the grant period.
  8. Include an itemized budget (preferably within proposal or may submit as attachment) for the full project, with justification and FTEs noted, and indicate which line items are being requested from MZHF. [Itemized expenses of up to $500 may be included in the proposal budget to cover materials for evaluation.] List any other committed, pending or prospective sources of funding for this project.