Equipment Request

Fraser Valley Health Care Foundation aims support the hospitals in the eastern Fraser Valley to enhance patient care, or assist in funding equipment or renovations not normally funded by Fraser Health.

To apply, please fill out the form below.

If you have any questions, please contact Liz Harris at liz.harris@fraserhealth.ca

Equipment Funding

"*" indicates required fields

1. Date of request*

MM slash DD slash YYYY

2. First name*

First

3. Last name*

Last

4. Job title*

5. Email*

6. Phone*

7. What hospital / location are you requesting this for?*

ARH

MMH

CGH

FCH

Other

8. What department are you requesting this for?*

9. Has this request been approved by your supervisor / manager?*

Yes

10. Supervisor/manager name and title*

11. Supervisor/manager phone number*

12. Supervisor/manager email*

13. Have you requested funding from anywhere else?*

Yes

14. If yes, please give amount requested and where you requested

15. When is the funding required by?*

16. Name of item requested*

17. Total dollar amount requested*

18. Quantity requested*

19. Please provide information about why this equipment / program is needed*

20. If approved, do you agree to notify the Foundation when equipment arrives?*

Yes

21. If approved, do you agree to send photos of the equipment and a quote to the Foundation for use in media?*

Yes

22. If approved, do you agree to send a thank you card / letter to donor when requested?*

Yes

23. Additional information to attach (please send in PDF format)*

Max. file size: 50 MB.

CAPTCHA

Building partnerships with individuals, local organizations and businesses to support local health care services within the Fraser Valley Regional Hospital District.

Home
About
Current Needs
Ways to Give
News
Events
Contact Us
Staff Resources

604-851-4890

Toll Free: 1-877-661-0314

info@fvhcf.ca

Donate Today

Website by WeMakeStuffHappen Logo

WeMakeStuffHappen® | Information for Donors

Equipment Request

Equipment Funding

Staff Resources