Sponsor Interest & Commitment Form

Sponsor Interest & Commitment Form

For the people doing everything right—and still priced out of healing.
501c3

EIN # 89-78365
Contact Information
Name

First NameLast Name
Organization/Business Name (if applicable)
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsorship Interest
We offer opportunities to sponsor individuals for a year of mental health support, or to give general donations that help remove barriers like childcare, transportation, and other urgent needs.
Sponsor individual directly. (one year of therapy access) $3000 Minimum.Provide general donations for emergency barriers.Monthly recurring gift.In-kind support. (services, event space, etc.)Not sure yet – please contact me
If known, what is your intended contribution amount or range?
Recognition & Preferences
YesNo
YesNoOther
YesNo
Communication & Follow-up
EmailPhone CallTextOther
How did you hear about The Thinkbox Co-Pay Project?
Is there anything else you'd like to share or ask us?
Acknowledgment

By submitting this form, you’re expressing interestin supporting the mental health journey of someone in need. We will follow up with more details and next steps. Thank you for being part of the solution.
Signature
Should be Empty:

Contact Information