Funding Request Form

Welcome to Santiam Service Integration Funding Request Form. We value our partners and are thankful Santiam Families have advocates such as you! If you have questions about this form or need assistance filling it out please contact Melissa Baurer, Santiam SI Coordinator, mbaurer@santiamhospital.org or 503-769-9319

Basic Funding Guidelines

Service Integration Team dollars are intended to meet an immediate one time need that achieves a measurable outcome towards health, wellness, and/or self-sufficiency. SIT funds are a last resort when all other community resources have been accessed or unavailable.

The online request form is intended for community partners and service providers only. If you are needing assistance with a personal need please contact The Salvation Army (503-585-6688) or Marion County Resource Center (503-399-9080).

Measurable Outcomes

Service Integration funds should be focused on meeting needs that can provide some measurable outcome (whether big or small).

Before submitting a request please read the Service Integration Funding Process Form and Service Integration Funding Guidelines which are found on the website: www.santiamhospital.org/sit.php 

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* 1. Please upload the Release of Information (one is required to be signed prior to an advocate completing the funding request). If you need a blank copy of a Release of Information please email mbaurer@santiamhospital.org requesting one or visit www.santiamhospital.org/sit/php 

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* 2. Referring Agency/Provider

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* 3. Client Information

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* 4. Please designate the team(s) from which you are requesting funds.

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* 5. Amount requested

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* 6. By when is the funding needed?

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