Circle of Excellence - Application Form

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Criteria Adherence

  • Eligibility: employees with 12 months of service or longer
  • Salary support: 80% or more
  • Duration: 4 weeks or more
  • No reduction in benefits (vacation, disability, etc.)

Do you meet Criteria Adherence:
 Yes    No


Optional Support

Do you provide paid time off for completion of tests and medical appointments that are part of the living donation assessment process?
 Yes    No


Do you provide additional support for living donors to defray costs of travel/lodging?
 Yes    No


Do you have cap on financial support per living donor?
 Yes    No


Do you have a cap on number of donors you will support annually?
 Yes    No


Do you have cap on annual expenditures?
 Yes    No





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