HOPE Endowment Fund
Criteria and process for awarding financial grants
What is the HOPE Endowment Fund?
The HOPE Endowment Fund is a permanent fund within the Brockville Community Foundation, established in 2004. The annual income earned on the fund is available to be distributed via registered Canadian charities to people in need, according to the policies of the Foundation. The capital of the fund remains untouched, and donors are invited to contribute to the endowed fund so that greater number of people may be helped.
What is the purpose of the Fund?
The objective is to provide financial support to people who need to go out of town for medical appointments and treatments, and who otherwise would be financially burdened by the cost, or otherwise would not be able to make the trip.
What are the basic eligibility criteria?
The applicant must be a resident of Leeds and Grenville.
The applicant requires areferral signature from doctor, nurse or health care professional. The applicant or referral professional can complete the application form
What types of thing qualify for funding?
Travel related expenses such as gas, train tickets, meals and accommodations. An amount will be calculated and the grant will be awarded prior to travel whenever possible. Receipts will be required upon return to verify the expenses. Funding will be awarded for travel for appointments and treatments, but not for medical procedures. A grant may be awarded for only a portion of the anticipated expenses.
How is an application assessed?
A committee which includes medical professionals will assess the application and award the grant based on financial need and urgency of medical attention required. In most cases a decision will be made within 48 hours.
How does a person apply for a grant?
Application forms are available from the Brockville Community Foundation’s web-site ( as well as at most medical offices, the Access Centre (address), Health Unit (address), Children’s Aid office (address), ODSP office (address). The application, along with a referral letter from a health professional, should be submitted to the Brockville Community Foundation office at (address)
How is a grant awarded?
The Brockville Community Foundation, as guided by the HOPE Committee, will forward a cheque to a local health-related charitable organization, who will in turn provide the funds to the individual (CHECK ON THIS..IF IT”S NOT MUCH, I THINK WE AT BCF CAN GIVE IT OUT DIRECTLY TO THE NEEDY PERSON).
How will the criteria bee updated, etc…
(SOME COMMENTS ABOUT THE THREE MEMBER COMMITTEE AND ANNUALLY REVIEWING THE CRITERIA, ETC…)
HOPE Endowment Fund
Application to receive financial assistance for travel expenses incurred
due to required medical treatment
Name of Person Requiring Medical Attention:Complete Address (including postal code):
Phone Number:
Email Address:
Other contact number (e.g. cell phone):
Other contact (e.g. Power of Attorney, Responsible Family Member, etc.):
Please note: the information collected in this application will be kept confidential and is only collected for the purposes of evaluating this request for financial assistance. The cost of treatment is not covered by this program - costs are for travel related expenses only. A referral letter from an authorized health professional must be attached to this application.
Medical Profile and Travel Expenses
Name of health professional making the referralPhone number
The Referral Letter must be attached to this application
Please describe the medical treatment you require.
How soon do you require this treatment?
Where (city, medical facility) do you have to travel to receive this treatment?
Will you have to stay in overnight accommodation, and for how many nights?
Other than travel, accommodation and meal expenses, are there any other travel related expenses that you will incur?
Financial Profile
Given your personal financial situation, do you feel that the expense of the travel required for this treatment is prohibitive? That is, would other necessary living expenses have to be delayed or given up in order to travel for this treatment? Please explain in your own words.
What is your annual household income?
What are your annual expenses?
Is there any other information that is directly pertinent to this application that you would like to share?
By signing below, you agree that the information presented is true and accurate to the best of your knowledge and ability. You also authorize the review committee to contact the referring health professional to discuss your application.
Signed: ______Dated: ______