Sponsorship Request Application
Florida KidCare sponsors events that support its mission to increase the number of insured kids in our state. In exchange for fee assistance, you will be asked to share Florida KidCare information and educate interested parties at the event. If your organization is participating in an upcoming event and would like to be considered for sponsorship, please fill out the application below.
1. Oranization Information for Funding Request
Organization Name
*
Provide a brief description about your organization and the population it serves.
*
Is this a 501(c)(3) organization?
*
Yes
No
Have you previously received a sponsorship from Florida Healthy Kids?
*
Yes
No
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2. Requestor Contact Information
Name of Funding Requestor
*
Job title
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
3. Event Information
Sponsorship Type
*
Booth/Table
Fair/Festival
Requesting a Representative
Conference
Other (Specify)
Sponsorship Amount
*
Name of Event
*
Event Website (if applicable)
Name of the Sponsoring Organization
*
Event Date
*
/
Month
/
Day
Year
Date
Event Time
*
Start Time
AM
PM
AM/PM Option
Until
until
End Time
AM
PM
AM/PM Option
Event Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
# of Anticipated Attendees
*
Target Audience for Event
*
Children
Families
Other
4. Funding Request Specifics
If the funding request is approved, how will the award be used?
*
What organization should the check be made out to (if approved) and where should it be mailed?
Organization Name
*
Oranization Address Same As Mailing Address in Section 1?
*
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If not previously submitted, please provide a copy of the organization's W-9 form.
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If applicable, please provide a copy of the event flyer(s).
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