Sponsorship Application - Summit Health

Contact Information

Organization Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Contact Person

Name *

First

Last

Phone *

Email *

Website *

Organization Information

Federal Tax ID *

Which service category best describes your organization? *

Is your organization a non-profit or public tax-exempt organization as defined under Section 501(c)(3) of the Internal Revenue Code? *

Yes
No

Geographic Service Area *

If other, please specify: *

Please provide a brief summary of your organization's mission: *

Who do you serve? *

Number of years in service: *

Request Details

Are you applying for a sponsorship or donation?

Sponsorship
Donation

Amount/Details *

Please specify amount for donation/sponsorship or details for your request.

How will Summit Health's contribution be used? *

What can we expect in return for our support? *

What other information should we know when reviewing your application?

Attachment

Click or drag a file to this area to upload.

Any proposal attached is not an alternative or substitute to completing the above form. Incomplete applications will not be considered for sponsorship or donation.