Ohiohealth Sponsorship Request Form printable pdf download

Ohiohealth Sponsorship Request Form

Community Relations

OhioHealth Sponsorship Request Form

Questions 1 – 15 Required

Have you reviewed OhioHealth’s In-Kind/Donation Request Guidelines? ☐YES OR ☐NO

Are you a 501(c)3 nonprofit organization as recognized by the IRS? ☐YES OR ☐NO

Organization Federal Tax ID Number:

Organization Name:

Organization Mailing Address:

Organization City, State, Zip:

Contact Person’s Name:

Contact Person’s Email:

Contact Person’s Phone:

10. Organization Mission Statement/Overview:

11. Describe and give a brief history of the event(s) or activity(s) you are requesting OhioHealth to support:

12. Program/event/project date(s) :

13. Describe the community benefit or community need addressed by your organization, and how this opportunity

connects with OhioHealth’s mission to improve the health of those we serve:

14. Sponsorships levels available (e.g., exclusivity, etc.), including list of title or other major collaborators:

15. Community(s)/Geographical area served:

16. Please list any current business contacts with OhioHealth that you have:

17. List any OhioHealth leadership or physician involvement with your organization, i.e. board or committee

positions:

18. Send PDF file to: .

☐ “I understand that in order to ensure this opportunity is included in OhioHealth’s strategic planning and budget cycle, requests must

be submitted by January of each year. Requests outside of this timeline will be reviewed at OhioHealth’s discretion.”

Ohiohealth Sponsorship Request Form