Sponsorship Request
Organization name
*
Organization phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact name
*
First Name
Last Name
Contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Mailing address (Where check will be sent if request is approved)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If your request is approved, who should the check be made out to?
*
Organization name as it should appear on the check
What are you requesting?
*
Please Select
Funding
Promotional items/giveaways
Room space
Other
Other:
*
Please provide an explanation of your request (funding amount or items requested, date of event, etc.)
*
Are you requesting sponsorship for an event?
*
Yes
No
What date do you need funding or materials by (Please note: Responses take up to 45 days)
*
-
Month
-
Day
Year
Date
Is this a healthcare or wellness related request?
*
Yes
No
Which of our community health improvement focus areas does your organization or program address?
*
Access to care
Food insecurity
Housing access
Addictions
n/a
Please explain
*
Who will benefit from this sponsorship? Check all that apply
*
Youth
Families
Seniors
Low-income
Homeless
Other
How many people are expected to benefit from this sponsorship?
*
How does your request provide community benefit?
*
What goals will this sponsorship help you accomplish?
*
How does this request fit within Adventist Health Portland's mission?
*
How does this request enhance Adventist Health Portland's impact in our community?
*
Are there any other organizations involved in this sponsorship?
*
Yes
No
Please list:
*
Has Adventist Health Portland ever sponsored or partnered with your organization before?
*
Yes
No
Not sure
Please provide any additional information you feel would be helpful or relevant to this request:
Support documents
Browse Files
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Upload any additional documents that would support your sponsorship request.
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Photos
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Upload any photos that tell the story of your organization or sponsorship request.
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