AHSR Sponsorship Request
Organization Name
*
Organization Phone Number
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Area Code
Phone Number
Contact Name
*
First Name
Last Name
Contact Person Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Mailing Address (where check should be sent if request is approved)
*
Address
Address Line 2
City
State / Province
Postal / Zip Code
Tax ID #
*
W9
Browse Files
To expedite funding, please upload a copy of your organization's W9.
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If your request is approved, who should the check be made out to?
Organization name, as it should appear on the check.
What are you requesting?
*
Funding
Promotional Items/Giveaways
Room Space
Other
How much funding are you requesting?
$100
$500
$1,000
$2,000
Other
Please provide an explanation of your request (funding amount or items requested, date of event, etc.)
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Are you requesting sponsorship for an event?
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Yes
No
What date do you need funding or materials by? (Please note, responses take up to 45 days)
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-
Month
-
Day
Year
Date
Is this a health care or wellness related request?
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Yes
No
Which of our Community Health Improvement focus areas does your organization or program address?
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Access to Healthcare
Mental and Behavioral Health
Chronic Disease
Housing and Homelessness
N/A
Please explain:
*
Who will benefit from this sponsorship? (Check all that apply.)
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Youth
Families
Seniors
Low-income
Homeless
Other
How many people are expected to benefit from this sponsorship?
*
How does your request provide community benefit?
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What goals will this sponsorship help you accomplish?
*
How does this request fit within Adventist Health Sonora's mission?
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How does this request enhance Adventist Health Sonora's impact in our community?
*
Are there any other organizations involved in this sponsorship?
*
Yes
No
Please list:
Has Adventist Health Sonora ever sponsored or partnered with your organization before?
*
Yes
No
Not sure
Please provide any additional information you feel would be helpful or relevant to this request:
Support Documents
Browse Files
Upload any additional documents that would support your sponsorship request.
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Photos
Browse Files
Upload any photos that tell the story of your organization or sponsorship request.
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Do we have your permission to reprint these photos to promote Community Well-being programs at Adventist Health Sonora?
Yes
No
Description of photo(s):
Describe the photo(s)
Participants' Names
List names of people in the photo(s)
By signing below you grant Adventist Health Sonora permission to reprint the photos you have uploaded, and you attest to gaining permission and authorization from each person portrayed inthe photo(s).
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