Community Contributions Application

Thank you for your interest in Covenant Health’s support for your charitable event or organization. Please submit your application 60-90 business days in advance of when funds are needed or in advance of the organization’s charitable event.

Contribution/Sponsorship Information

Name of Event or Contribution/Sponsorship Opportunity(Required)

Name of Organization Requesting Contribution/Sponsorship(Required)

Purpose and description of event or initiative for which sponsorship/contribution is requested(Required)

Is contribution/sponsorship request for an event?(Required)

Yes

Where will the event take place?

On what date will the event take place?

Amount requested for contribution/sponsorship(Required)

Are multiple sponsorship levels available?(Required)

Yes – Please attach details about sponsorship levels below

How would Covenant Health’s contribution/sponsorship be used in supporting this event/initiative?(Required)

How will sponsorships/contributions be acknowledged?(Required)

Other community sponsors of the event/initiative(Required)

Organization Information

Organization Name(Required)

Address(Required)

Street Address City State ZIP Code

Web address

Purpose and description of the organization(Required)

Is the organization a 501(c)3?(Required)

Yes

Provide examples of other community sponsors/supporters of your organization(Required)

Contact Information

Contact Name(Required)

Contact Title(Required)

Contact Phone(Required)

Contact Email(Required)

File

Max. file size: 50 MB.

CAPTCHA

Additional Information

Decisions will be communicated to the designated contact person via email within 30-60 days of application. Because Covenant Health receives many requests for sponsorships and contributions, charitable organizations may request support only once per calendar year. Organizations, events or initiatives funded in any one calendar year are not assured of future funding. If renewed funding is desired, the organization must submit a new request in the next calendar year.

If you have questions, please email [email protected].