Community Sponsorship Support Request Form
Please select the type of sponsorship support you are seeking (select all that apply):
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Sponsorship
Health/Wellness speaker(s)
Health/Wellness print materials
Booth/vendor participation
Promotional items
Other
Organization name
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Organization type
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Please Select
501c status/not for profit
For-profit
Government entity
School
Requester's Information
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First and Last Name, Role or Title, Email Address, Phone Number
Organization Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide a summary of the support request
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(400 characters or less) If this is an event, please include expected number of individuals in attendance. Please also include date, time, and title of event
Prioritization
Preference will be given to requests that support Reid Health's strategic priorities. Which one(s) is/are your organization/activity supporting?
Request Category (select all that apply)
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Mental health and substance misuse
Maternal, fetal, and children's health
Physical activity, nutrition, and weight status
Disease prevention and management
Arts and cultures
Environment
Economic development
Quality of life
Select county served
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Wayne
Randolph
Fayette
Union
Henry
Franklin
Preble
Darke
Form Date Field
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Required attachment(s)
Please upload supporting documentation detailing sponsorship benefits and your organization's W-9.
File Upload
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Request review
Your request will be reviewed by an internal committee. We will follow up with you by email. Thank you.
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