How We Help

Established in 2010, MCF continues to expand its programs and offerings to Maxim Healthcare Services employees, Amergis Healthcare Staffing employees, and local communities. MCF is led by a board of volunteers that meets regularly to oversee the work of the foundation. Our ultimate vision is to touch the lives of those in need through generous donations from MCF supporters.

California – LA Fire GRANTS

Due to the state of emergency in California, the MCF has enacted the Emergencies & Natural Disaster protocol. The emergency response protocol will be live and MCF will expedite applications now through Tuesday, January 28. After that date, all applications will need to be submitted through the traditional application process. For those of who you have not been impacted but have a desire to support, MCF has implemented a donation opportunity to specify that your funds specifically are for the LA fires, here.

Application for the Granting of Funds

This form provides the information required for applications to be considered for the granting of funds from the Maxim Charitable Foundation. Please complete all information, with the exception of the signature line, and email to MCF@amergis.com and MCF@Maxhealth.com. This application will be considered only if all requested information is provided.

Personal Information:

Last name:

First name:

Employee ID/SSN (last 4 digits):

Employee Address:

Position:

Date of Hire:

Employee Phone:

Employee Email:

Race (optional):

Hardship Information:

Please describe in detail the nature and circumstances surrounding the application. Include below a detailed statement about the personal hardship that you are facing and how funding from the Maxim Charitable Foundation can assist. Please attach documentation such as copies of doctors statements, agency reports, and outstanding bill payments. (Additional sheets may be attached as necessary.) Upon completion, please forward original to your Manager.

Select Hardship Classification: Please answer the following questions as they relate to the hardship described above:

  1. Have you been without income
    • If yes, for how long?
  2. What is your average bring-home pay (weekly)?Do you have any other sources of income? (e.g. short term disability)
  3. What is your marital status?
  4. Do you have any dependents for whom you are legally responsible?
    • If yes, please list the age of each dependent
  5. Have you applied for a foundation grant in the past?
    • If yes, what was the date?
  6. Do you have any PTO remaining for your use?
    • If yes, how much?
    • If yes, what are the other sources:

Note: If you are unable to work due to a medical condition, please include a physician’s statement with application