One 4 One Giving Application

Nexion Health Foundation matches donations made by eligible Nexion Associates to one qualified local, regional, or national charitable organization per year through the One 4 One Giving Program. Associates are eligible the 1st month following the Associate’s 90 days of consecutive full-time employment. A One 4 One Giving contribution check will not be made payable to an individual. Annual contributions to any one organization may be limited and is based on the decision of the Foundation Board of Directors.

To apply, complete and submit this Application form, along with a copy of the organization’s 501(c)(3) and proof of your contribution(s). Please see below for further requirements. Completed Applications must be submitted by December 31.

Date(Required)

MM slash DD slash YYYY

Daytime Phone(Required)

Applicant Name(Required)

First Last

Applicant Title(Required)

Applicant Email(Required)

Facility Name(Required)

Applicant Full-Time(Required)

Yes

Date of Hire(Required)

MM slash DD slash YYYY

Legal Name of Eligible Organization(Required)

Community projects supported by this organization(Required)

Amount Requested(Required)

Organization Contact Information

Contact Person(Required)

First Last

Phone(Required)

Fax

Email Address(Required)

Website(Required)

Address of Organization(Required)

Street Address City State ZIP Code

PLEASE SUBMIT THE FOLLOWING DOCUMENTATION:

A copy of the organization’s IRS Federal Tax Exemption Determination (501(c)(3) Letter)
A dated receipt from the organization which documents your personal contribution(s) during the current calendar year
A copy of your cancelled check or a detailed credit card statement that verifies your personal contribution during the calendar year.

Federal Tax Exemption(Required)

Max. file size: 15 MB.

A copy of the organization’s IRS Federal Tax Exemption Determination (501(c)(3) Letter)

Personal Contribution: Receipt(Required)

Max. file size: 15 MB.

A dated receipt from the organization which documents your personal contribution(s) during the current calendar year

Personal Contribution: Statement(Required)

Max. file size: 15 MB.

A copy of your cancelled check or a detailed credit card statement that verifies your personal contribution during the calendar year

Apply online by submitting completed Application, 501(c)(3) letter and proof of contribution(s) or submit to:
Nexion Health Foundation, 6937 Warfield Ave., Sykesville, MD 21784

The Nexion Health Foundation seeks to improve the lives of those who live and work in the communities served by Nexion Health facilities through a variety of financial assistance and gift-giving programs. The Foundation is dedicated to addressing the needs of non-profit organizations and charities that serve the elderly and disabled. The Foundation also funds a variety of programs designed to enrich the lives of Nexion Associates who demonstrate a commitment to long term care. All funding will be determined on a case by case basis and approved by the Foundation Board.

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