Funds Request Forms

In order to request funds from the Deaconess Hospital Alumni Association for educational opportunities, you will need to print and complete all three forms on this Education Funds link. You will need to complete the following forms: Deaconess Hospital School of Nursing Alumni Fund Request; Deaconess Hospital Foundation Request for Foundation Funds Allocation; and Request for Check. Read and follow the directions which appear within this link and on the documents for the completion of these forms.

  • The DHSON Alumni Fund Request: fill out the top portion. If you are a graduate, but not a current member of the Alumni Association, please send your $5 yearly dues to Libby Ketchem at Deaconess Wound Services, Deaconess Hospital, 600 Mary Street, Evansville, IN, 47747.
  • The DH Foundation Request: fill the top portion out completely. Please get your department director/manager's signature.
  • The Request for Check: the Foundation requires that the check be made to the seminar, hotel, etc. rather than to an individual. Every check requested must have a separate check request form submitted. Make copies, if needed. [Attach all registration form(s) and/or receipt(s).]
  • If you need assistance with this form, call Libby Ketchem at 450-7703.
  • Mail completed forms and other appropriate documentation (receipts, copy of registrations, etc.) to Libby Ketchem at Deaconess Wound Services, Deaconess Hospital, 600 Mary Street, Evansville, IN, 47747.