Sponsorship/Donation Request Form

Sponsorship/Donation Request Form
If you woud like TriState Health to consider a request for sponsorship, donation, or support for a community event, please review our criteria and submit your request using this form. Submissions are reviewed on a monthly basis, and a representative will reach out to you to follow-up once your application has been reviewed. NOTE: Requests without a form will not be considered. Completion of this form does not guarentee acceptance. All requests must be accompanied by an official tax ID form.
Criteria

Requests must meet the following criteria:
- Must be received at least 30 days prior to the deadline
- Must satisfy at least one requirement below:
  - Align with TriState Health's mission, vision, and values
  - Improve access to healthcare
  - Promote health and wellness to the community
  - Support economic development within our community
  - Support the workforce within our community
  - Be an accredited school benefiting children within our community
The following requests WILL NOT be considered for support:
- Programs outside of 100 miles from Clarkston, WA
- Individuals or individual fundraising efforts (single players on teams, etc.)
- Political campaigns, candidates, parties, or partisan activities
- Fellowships or internships
- Events that feature alcohol or tobacco products
Contact Information
Organization Name
Organization Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your organization a not-for-profit?

YesNo
Contact Name

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Website URL
Request Information
Type of Request

SponsorshipDonationRaffle/Silent Auction ItemsParticipation in Community Event
Please upload your sponsorship levels and proposals here (if any)

Cancelof
If sponsorship, amount requested
Choose one option that best describes your sponsorship or donation request

Improve Access to HealthcarePromote Health and WellnessWorkforce DevelopmentEconomic DevelopmentAccredited SchoolNon-Health Related
Deadline Date
How will this sponsorship or event benefit the community?
Will TriState Health receive promotional opportunities? (banner, advertisement, t-shirts, booth, etc.)

YesNo
Include Promotional Opportunities Below
Event Information
Event Name
Event Date
Event Time
Event Location
Description of Event
Target Audience at Event
Expected Number of People Attending Event
Will TriState Health be the only healthcare sponsor?

YesNo
Additional Details
Tax ID form

You must attach your official tax ID form, along with and any additional information you would like to include. NOTE: All requests must be accompanied by an official tax ID form to be considered.
File Upload

Cancelof
Should be Empty:

Sponsorship/Donation Request Form

Contact Information

Request Information

Event Information

Tax ID form