NRHA Rural Hospital Partnership Application

IMPORTANT: PLEASE READ BEFORE PROCEEDING

The National Rural Health Association Rural Hospital Partnership Program is built for organizations that have earned the trust of rural healthcare providers through measurable results and a demonstrated commitment to improving rural healthcare.

By submitting this application, you are affirming that your organization is prepared to demonstrate that commitment through documented outcomes, rural customer references, and active participation in the program. Partners are expected to share proven rural expertise, provide knowledgeable subject matter experts, develop high-quality educational content, meet program deadlines, and actively participate throughout the partnership year.

Because partnership opportunities are limited and competitively reviewed, organizations selected by the review committee should be prepared to execute a partnership agreement upon acceptance.

If you have any questions about the program, application requirements, or whether your organization is a good fit, please contact us before submitting your application. We are happy to answer questions and help you determine if the program aligns with your organization's goals.

Name of person completing the application

First NameLast Name

Your Title

Your Email

example@example.com

Phone Number

Area CodePhone Number

Organization

Website URL

Year founded

Legal Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of person to sign the contract (Ultimate Decision Maker)

First NameLast Name

Signer Title

Signer Email

example@example.com

Rural health expert who will represent your organization

This person should be familiar with rural hospital buying cycles and culture and be able to speak the language of rural healthcare.Last Name

Expert Title

Expert Email

example@example.com

Rural Hospital and Clinic Experience

Has your organization developed, or is it currently developing, educational content focused on rural healthcare?

Please upload 2–3 examples of educational or marketing materials your organization has developed for a rural healthcare audience.

Browse Files

Examples include webinars, presentations, case studies, blogs, white papers, email campaigns, infographics, or other educational resources.

How is your organization's marketing managed?

If you selected third-party marketing, please provide the name of the agency or consultant.

Briefly describe the services and solutions your organization offers.

How many rural facilities is your organization currently working with?

Which best describes your organization?

What is your organization's annual budget for marketing to rural healthcare audiences?

Does your organization have an internal marketing department?

Does the company have a Diversity, Equity and Inclusion policy? If so, briefly describe:

Reference 1 – Organization Name

Reference 1 – Contact Name

First NameLast Name

Reference 1 – Contact Title

Reference 1 – Contact Phone

Area CodePhone Number

Reference 1 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 1 – Description of business relationship

Reference 1 – Length of relationship

Reference 2 – Organization Name

Reference 2 – Contact Name

First NameLast Name

Reference 2 – Contact Title

Reference 2 – Contact Phone

Area CodePhone Number

Reference 2 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 2 – Description of business relationship

Reference 2 – Length of relationship

Reference 11 – Organization Name

Reference 11 – Contact Name

First NameLast Name

Reference 11 – Contact Title

Reference 11 – Contact Phone

Area CodePhone Number

Reference 11 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 11 – Description of business relationship

Reference 11 – Length of relationship

Reference 12 – Organization Name

Reference 12 – Contact Name

First NameLast Name

Reference 12 – Contact Title

Reference 12 – Contact Phone

Area CodePhone Number

Reference 12 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 12 – Description of business relationship

Reference 12 – Length of relationship

Reference 10 – Organization Name

Reference 10 – Contact Name

First NameLast Name

Reference 10 – Contact Title

Reference 10 – Contact Phone

Area CodePhone Number

Reference 10 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 10 – Description of business relationship

Reference 10 – Length of relationship

Reference 3 – Organization Name

Reference 3 – Contact Name

First NameLast Name

Reference 3 – Contact Title

Reference 3 – Contact Phone

Area CodePhone Number

Reference 3 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 3 – Description of business relationship

Reference 3 – Length of relationship

Reference 4 – Organization Name

Reference 4 – Contact Name

First NameLast Name

Reference 4 – Contact Title

Reference 4 – Contact Phone

Area CodePhone Number

Reference 4 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 4 – Description of business relationship

Reference 4 – Length of relationship

Reference 5 – Organization Name

Reference 5 – Contact Name

First NameLast Name

Reference 5 – Contact Title

Reference 5 – Contact Phone

Area CodePhone Number

Reference 5 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 5 – Description of business relationship

Reference 5 – Length of relationship

Reference 6 – Organization Name

Reference 6 – Contact Name

First NameLast Name

Reference 6 – Contact Title

Reference 6 – Contact Phone

Area CodePhone Number

Reference 6 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 6 – Description of business relationship

Reference 6 – Length of relationship

Reference 7 – Organization Name

Reference 7 – Contact Name

First NameLast Name

Reference 7 – Contact Title

Reference 7 – Contact Phone

Area CodePhone Number

Reference 7 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 7 – Description of business relationship

Reference 7 – Length of relationship

Reference 8 – Organization Name

Reference 8 – Contact Name

First NameLast Name

Reference 8 – Contact Title

Reference 8 – Contact Phone

Area CodePhone Number

Reference 8 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 8 – Description of business relationship

Reference 8 – Length of relationship

Reference 9 – Organization Name

Reference 9 – Contact Name

First NameLast Name

Reference 9 – Contact Title

Reference 9 – Contact Phone

Area CodePhone Number

Reference 9 – Contact Work Email

Please use the contact's work email, not a personal address.

Reference 9 – Description of business relationship

Reference 9 – Length of relationship

Next Step: References

After your application is reviewed, NRHASC will provide a link to the Reference Sheet, where you will be asked to identify 12 current clients from rural hospitals, rural health systems, or rural clinics that have directly utilized your organization's products or services for at least 12 months. References must come from rural healthcare provider organizations, not vendors, consultants, associations, or other industry partners.

Each reference will be asked to complete a short, confidential form submitted directly to NRHASC. Only applicants who advance beyond the initial application review will be asked to provide references.

We acknowledge that our organization has at least 12 current rural healthcare references, each with an established professional relationship of at least one year, who can attest to our work and our commitment to supporting rural hospitals and healthcare delivery.

Authorized Signature

National Rural Health Association Rural Hospital Partnership Application