Volunteer Plus Application

Nexion Health Foundation provides financial assistance to eligible charitable organizations for which Nexion Associates volunteer their time and talent serving their community and supporting the health, well-being, and futures of the elderly and disabled, their families and caregivers. Associates are eligible the 1st month following the Associate’s 90 days of consecutive full-time employment. Annual contributions to any one organization shall not exceed $250 and will be limited annually to two (2) organizations per eligible Associate. Annual contributions are based on the decision of the Foundation Board of Directors.

To apply, complete and submit this Application form, along with along with a copy of the organization’s 501(c)(3) letter and proof of at least 25 hours of unpaid service to a qualified organization. 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)

Volunteer Work Provided to 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 letter from the organization that verifies your number of hours and description of volunteer work

Federal Tax Exemption Determination(Required)

Max. file size: 15 MB.

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

Volunteer Contributions Verification(Required)

Max. file size: 15 MB.

A letter from the organization that verifies your number of hours and description of volunteer work

Apply online by submitting completed Application, 501(c)(3) letter and proof of volunteer service 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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