Contribution Application Form
This form must be completed to have your submission reviewed by the Contributions & Community Relations team; incomplete applications will not be considered.
Organization name
*
Request date
*
-
Month
-
Day
Year
Date
Type of contribution being requested:
*
Charitable Contribution - a monetary gift to non-profits and other organizations whose mission, objectives, goals and initiatives concur with CentraCare
Sponsorship - financial support of a community event or fundraiser in exchange for CentraCare advertising and/or logo placement
In-Kind Donation - donation of door prizes and/or give-away items to support a community event or fundraiser
Primary location community request is for:
Benson
Long Prairie
Melrose
Monticello
Paynesville
Redwood Falls
Sauk Centre
St. Cloud
Willmar
No specific location
Other
Amount Requested
Maximum amount = $2,500
Primary contact for this request
*
First Name
Last Name
Phone
*
Please enter a valid phone number.
Email
*
example@example.com
Has support from CentraCare been provided to your organization for any purpose/program over the past three years? Please list.
Is there a CentraCare employee(s) associated with your group or this donation request? If yes, please list name(s).
Describe the program/activity that you are submitting for funding consideration.
What is the timeline for the activities related to this request?
How will you recognize CentraCare for this contribution?
What is the current community need related to this request?
How many participants will be served?
What are the goals and expected outcomes of the activities?
Additional attachments
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