Sponsorship Request: Adventist Health St. Helena

Sponsorship Request: Adventist Health St. Helena
Organization Name
Organization Phone Number

Area Code Phone Number
Contact Name *

First Name Last Name
Contact Phone Number

Area Code Phone Number
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Tax ID number *
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What are you requesting?
Please provide an explanation of your request (funding amount, promotional items, age group/audience, date of room use, other, etc.). *
Are you requesting sponsorship for an event? *

Yes No
What date do you need materials by? (Please note: responses take up to 45 days)

Month Day Year
Is this a healthcare or wellness related request? *

Yes No
How does your request provide community benefit? *
What goals will this sponsorship help you accomplish? *
Tell us how this request meets one of the needs outlined in our Community HealthNeeds Assessment *
How does this request enhance Adventist Health St. Helena's visibility/impact in our community? *
Are there any other organizations involved in this sponsorship? *

Yes No
If so, who?
Has Adventist Health St. Helena ever sponsored or partnered with your organization before?

Yes No
Please provide any additional information you feel would be relevant to this request *
Support Documents

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Upload any additional documents that would support your sponsorship request. Cancel of
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