Sponsorship Form (Request)
Please provide your contact information so our team can follow up regarding your request.
Full Legal Name
*
Preferred Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City
*
State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code
*
Are you a PPCM survivor?
*
Yes
No
Are you currently a Let’s Talk PPCM Volunteer or Contractor?
*
Yes
No
How long have you been connected with Let’s Talk PPCM?
Please Select
Less than 6 months
6–12 months
1–2 years
More than 2 years
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Tell Us About Your Initiative
We want to learn about the work you're doing and how it connects to our mission.
Project/Event/Initiative Name
*
Type of Initiative
*
Community event or gathering
PPCM awareness campaign
Maternal heart health education
Survivor support initiative
Community outreach
Advocacy project
Workshop or educational activity
Resource distribution
Other mission-aligned project
Describe your initiative
*
What inspired you to start this initiative?
What are the primary goals?
*
Who will benefit from this initiative?
*
Expected number of people reached
*
Project start date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Project end date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location or service area
*
Project format
*
In-person
Virtual
Hybrid
Ongoing initiative
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Tell Us About Your Funding Needs
Let us know how much assistance you are requesting and how the funding will help bring your initiative to life.
Requested Sponsorship Amount
*
Please Select
$100
$150
$200
$250
$300
$400
$500
Total Estimated Project Budget
*
How much funding have you secured so far?
*
Are you receiving support from other sponsors?
*
Yes
No
Have you applied for funding elsewhere?
Yes
No
Explain why sponsorship assistance is needed
*
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How Will the Funds Be Used?
This is one of the most important sections because it allows Let’s Talk PPCM to see exactly where its money will go.
Explain how you plan to use the requested sponsorship funds.
*
Venue or Space Rental
Educational Materials
Printing and Promotional Materials
Event or Project Supplies
Community Outreach Expenses
Transportation or Delivery
Other Approved Project Expenses
Explain any other expenses
Total Requested Expenses
Upload Proposed Budget
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Tell Us About the Impact
These questions help us understand the value of the initiative beyond the financial request.
What impact do you hope to make?
*
How will this initiative promote PPCM awareness or maternal heart health?
*
How will survivors or families benefit?
*
Will this initiative involve other organizations or community partners?
*
Yes
No
If yes, list your partners.
Is this a new or recurring initiative?
*
New initiative
Recurring initiative
Additional information
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Our Partnership Commitment
Let’s Talk PPCM is proud to support Heart Sisters who are making a difference. If approved, we ask recipients to help us acknowledge the organization's contribution and share the impact of the support provided.
Will you acknowledge Let’s Talk PPCM as a sponsor or supporter?
Yes
No
Can you include our official logo on applicable promotional materials?
Yes
No
Will you tag or mention Let’s Talk PPCM on relevant social media posts?
Yes
No
Will you submit a brief post-project recap?
Yes
No
Social media account or website links
Recognition Expectations
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Application Agreement
Funding Guidelines
Applicant acknowledgments
*
I certify that the information provided in this application is accurate.
I agree to use approved funds only for the purpose outlined in my application.
I agree to the program's recognition and post-project reporting expectations.
I understand that submitting an application does not guarantee funding.
Applicant Signature
*
Date Submitted
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Upload Event Flyer or Project Overview
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Upload Additional Supporting Documents
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