Sample Application Overview

Mount Zion Campus-based Awards: The following information is required to complete an 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(s) Phone(s)
Dept./Division Email
Campus 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: briefly state the main goal(s) of the requested funding (2-3 sentences) and 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 the UCSF Mount Zion Campus. State whether the project is based at UCSF Mount Zion Campus, and describe how the project enhances care and/or medical education/training 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 health equity or other compelling San Francisco or UCSF Mount Zion healthcare priorities. Explain how the project addresses health equity or other compelling San Francisco or UCSF Mount Zion healthcare priorities 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 the project’s success in meeting its stated goals. To receive funding, the proposal must include a plan for evaluation with 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 (if an ongoing intervention is proposed).
  8. Include an itemized budget with justification and FTEs noted (preferably within proposal or may submit as attachment) for the full project, 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.]
  9. List any other committed, pending or prospective sources of funding for this project.