The recipient entity's physical address:
           301 Memorial Dr.
Donaldsonville, LA 70436

The recipient entity's mailing address (if different):
           301 Memorial Dr.
Donaldsonville, LA 70436

Type of Entity (for instance, a nonprofit corporation):  Other

If the entity is a corporation, list the names of the incorporators:
          

The last four digits of the entity's taxpayer ID number:  0

What is the dollar amount of the request?  $25,000

What type of request is this?  General Appropriation

Is this entity in good standing with the Secretary of State?  Not Applicable

Provide the name of each member of the recipient entity's governing board and officers:
           Mr. William “Bill” Dawson, Chairman-301 Memorial Dr., Donaldsonville, LA
Mr. Falcon Mire, Vice-Chairman-301 Memorial Dr., Donaldsonville, LA
Dr. Charie Mitchell Levy, Secretary/Treasurer-301 Memorial Dr., Donaldsonville, LA
Ms. Tanya Scott Mitchell, Board Member-301 Memorial Dr., Donaldsonville, LA
Mrs. LaDarby Williams, Board Member-301 Memorial Dr., Donaldsonville, LA
Mr. Shelton Anthony, CEO

Provide a summary of the project or program:
           West Ascension Parish hospital will use the funds to support its 2026 summer jobs/intern program whereby local high school juniors and seniors interested in exploring careers in the medical profession can get hands on experience by working alongside the medical professionals employed with West Ascension Parish Hospital.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $15,000
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $10,000

Does your organization have any outstanding audit issues or findings?  No

If 'Yes' is your organization working with the appropriate governmental agencies to resolve those issues or findings?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          West Ascension Parish hospital will use the funds to support its 2026 summer jobs/intern program whereby local high school juniors and seniors interested in exploring careers in the medical profession can get hands on experience by working alongside the medical professionals employed with West Ascension Parish Hospital.

What are the goals and objectives for achieving such purpose?
          West Ascension Parish hospital will use the funds to support its 2026 summer jobs/intern program whereby local high school juniors and seniors interested in exploring careers in the medical profession can get hands on experience by working alongside the medical professionals employed with West Ascension Parish Hospital.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           8 weeks

If any elected or appointed state official or an immediate family member of such an official is an officer, director, trustee, or employee of the recipient entity who receives compensation or holds any ownership interest therein:
     (a) If an elected or appointed state official, the name and address of the official and the office held by such person:
                 NA
    
     (b) If an immediate family member of an elected or appointed state official, the name and address of such person; the name, address, and office of the official to whom the person is related; and the nature of the relationship:
                 NA

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                 NA

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                  NA

If the recipient entity has a contract with any elected or appointed state official or an immediate family member of such an official or with the state or any political subdivision of the state:
(a) If the contract is with an elected or appointed state official, provide the name and address of the official and the office held by such person: 
               NA

(b) If the contract is with an immediate family member of an elected or appointed state official:
          Provide the name and address of such person:
               NA

          Provide the name, address, and office of the official to whom the person is related:
                NA

          What is the nature of the relationship?  NA

(c) If the contract is with the state or a political subdivision of the state, provide the name and address of the state entity or political subdivision of the state:
                 NA

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               NA


Contact Information
name:  Shelton Anthony 
                                       address:  301 Memorial Dr.
Donaldsonville, LA 70346
                                       phone:  337-290-0837
                                       fax: 
                                       e-mail:  shelton.anthony@westaph.org
                                       relationship to entity:  CEO