Sponsorship/Resource Request

Sponsorship & Resource Request

Community Sponsorship & Resource Request Form
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Is this request for a Sponsorship or Resource Table?*

SponsorshipResource table only
Organization name*
Organization address*

Street Address

Street Address Line 2

CityState

Zip Code
Website
Contact Person*

First NameLast Name
Phone number:*
Email*
example@example.com
Is your organization a non-profit or public tax-exempt organization as defined under Section 501(c)(3) of the Internal Revenue Code?*

YesNo
TIN/EIN # (if applicable):
A new vendor form must be submitted along with a W-9. You can find these forms here:
- New Vendor Form
- W-9 Form
New Vendor Form & W-9 *

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Describe Your Organization:*
If requesting funding for a specific project or event, briefly describe how you plan to raise funds, expected attendance number, location, and description of the project/event.*
Is a Resource Table included in the sponsorship?*

YesNo
Is the table supplied or do we need to bring a table?

SuppliedBring your own table
Date of event *

MonthDayYear
Date
Event Time*

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
Location of Event*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Description
Have a flyer for your event? Share it with us!

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When do you need to receive the donation?*

MonthDayYear
Date
Requested amount
What specific benefits/outcomes will be realized with this donation?*
How will Health Solutions be recognized, promoted, or benefit from this contribution?*
Consent*

On behalf of my organization, I have read and understand the Community Donation Guidelines as stated by Health Solutions & Spanish Peaks Foundation for Health.
Should be Empty:

Sponsorship & Resource Request