Grant Request Application

The Percival P. Baxter Foundation’s vision is to eliminate barriers and foster the advancement of Maine’s Deaf and hard of hearing children and their families.

We are pleased to offer grant funding in support of this vision. Subject to approval of the foundation’s Board of Directors and to the funding limits outlined below, grant funding is available for: (a) the cost of programs (e.g., conferences, camps, seminars) aligned with the foundation’s vision; (b) travel costs for medical visits and program attendance; and (c) the costs of supplies needed for COVID mitigation (e.g., masks, PPE).

Please note the following eligibility requirements for all funding requests:

Applicant must be a Maine resident.
Requests for medical visit travel costs and for COVID mitigation supplies are restricted to the immediate family members of a Deaf or hard of hearing child (i.e., parent, stepparent, foster parent, legal guardian, or grandparent).
Requests for medical visit travel costs and for COVID mitigation supplies are limited to $500 per request.
Requests for program attendance and related travel costs are restricted to family members of a Deaf or hard of hearing child or to any professional that regularly interacts with Deaf or hard of hearing children.
Requests for program attendance and related travel costs are limited to $1,000 per request.

All applications must be submitted in full. If you have questions about the application or the grant program, please contact the foundation at ppbfme@gmail.com.

Applications are reviewed at the monthly Board of Directors meeting. With limited exception, the Board meets on the first Monday of every month and funding can be issued within the month of approval. Please submit your application sufficiently in advance to allow the Board the opportunity to review your request and to issue funding. Approval is subject to the Board’s discretion.

Name

First Name

Last Name

Subject

Message

Applicant Information

Applicant Name:

Applicant Email Address:

Applicant Phone Number

(###)

###

####

Applicant Home Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If applicable, name of Deaf or hard of hearing child:

First Name

Last Name

Applicant's relation to child:

Nature of grant:

Select one:

Program attendance and related travel(e.g., conference, camp, seminar)

Medical visit travel costs

COVID19 mitigation supplies

Other (Please include detail below)

Other

If you have indicated “Other”, please explain the nature of your grant request and how it aligns with the vision of the Baxter Foundation.

PROGRAM ATTENDANCE AND RELATED TRAVEL COSTS

Name of Program:

Program website (if available):

http://

Program Location:

Dates of Attendance:

Cost of Attendance (not including travel):

Please note that for ease of administration the Baxter Foundation uses the high/low method for travel reimbursement. Under this method, we only need to know how many people are travelling and whether lodging is required. Depending on the travel location and whether it is considered high-cost (as determined by the IRS), reimbursement will be limited to the following: If lodging is required, $296 per person per day for high-cost locations and $202 per person per day for other locations. If lodging is not required, $74 per person per day for high-cost locations and $64 per person per day for other locations.

How many people are traveling?

Will lodging be required?

Justification:

Please provide a brief explanation for the importance of the program and how it aligns with the foundation’s vision.

MEDICAL VISIT TRAVEL COSTS

Name of Medical Facility/Office

Facility/Office website (if available):

http://

Facility/Office Location:

Date(s) of Visit:

Please note that for ease of administration, the Baxter Foundation uses the high/low method for travel reimbursement. Under this method, we only need to know how many people are traveling and whether lodging is required. Depending on the travel location and whether it is considered high-cost (as determined by the IRS), reimbursement will be limited to the following: If lodging is required, $296 per person per day for high-cost locations and $202 per person per day for other locations. If lodging is not required, $74 per person per day for high-cost locations and $64 per person per day for other locations.

How many people are traveling?

Will lodging be required?

Justification:

Please provide a brief explanation of the nature of the medical visit.

COVID19 MITIGATION SUPPLIES

Funding Amount Request

Website Showing Product Description/Pricing:

http://

Justification:

Please provide a description of the supplies requested and why they are being requested.

OTHER REQUEST

Funding Amount Request:

Justification:

If you are requesting funding for anything other than program and related travel costs, medical travel costs or COVID mitigation supplies, please include a detailed justification for the amount of funding requested.

Please make sure you've filled out all required fields and hit submit below. Thank you!