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Alicia Rose " Victorious " Foundation Grant Application
HISTORY :
The Alicia Rose " Victorious " Foundation awards restricted grants to pediatric hospitals and facilities that treat in-patient teenagers, ages 12 and up, who are facing life-threatening illnesses. The Restricted Grant ranges from $5,000 to $15,000. This Restricted Grant is to be used solely for the purposes of providing items for use in the Teen Lounge. The items shall be limited to fixed equipment, technology, entertainment, crafts, "Teen Library", "Teen Kits", Bandana Pillows, furnishings, and teen social activities. Suggested components of a Teen Lounge have included:
- 42" Plasma TV with speakers and a wall mount
- Sony 400 + DVD/CD player
- DVD's rated PG-13 and under
- Jukebox, Satellite Radio Boom box, or iPod docking station w/iPod
- High Power PC's w/ DVD/CD burners
- Color Printers
- 17" Flat Monitors
- Teen Library
- Gaming systems such as WII, XBOX 360, Playstation, etc. with games and controllers
- Furnishings
ELIGIBILITY QUALIFICATIONS:
Our mission statement directs our selection process for restricted grants include the following:
- Treat teenagers (ages 12 and up) with life-threatening illnesses
- Treat a minimum of 120 in-patient teens with life-threatening illnesses annually on an in-patient basis.
- Have a room at least 10 x 10 that can be used as a " Teen Lounge"
REQUIRED HOSPITAL COMMITMENT:
Within four months of receipt of this Restricted Grant, the hospital is required to:
- Recognize that elements of the "Teen Lounge" were donated by the Alicia Rose " Victorious " Foundation by placing a visibly located plaque in or outside the door of the Teen Lounge.
- Submit a full and complete itemized listing on all items purchased for the " Teen Lounge". The responsible party should attest to this statement. Proceeds of this grant may not be used for purposes other than those specifically outlined herein.
- Provide photos of the completed Teen Lounge.
- Grant permission to allow the Alicia Rose " Victorious " Foundation to promote the Teen Lounge in our newsletter and fund raising efforts.
- Computers in " Teen Lounge" must include a link to our web-site (www.victoriousfoundation.org)
- Press Release to 2-3 local newspapers and/or TV stations.
- Invitation to the "Grand Opening" of the completed Teen Lounge (if applicable), and/or open-ended tour of the facility.
- Acknowledgement of the grant in the hospital's newsletter and/or annual report.
- The proceeds of this grant may only be used for charitable, literary or educational purposes. No part of the proceeds may be used for the private benefit of a shareholder, director or trustee of the recipient organization. No substantial part of the proceeds may be used for the carrying on of propaganda or otherwise attempting to influence legislation (except as specifically permitted in accordance with 26 U.S.C. 501(h)) or in attempting to participate in, or intervene in any political campaign on behalf of any candidate for public office.
- Obtain consent forms for pictures to be utilized by Alicia Rose " Victorious " Foundation for publicity.
A grant application is attached if you are interested in being considered for a grant.
Click here for the application
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