CCN Community Partnership Application

Community Partnership Application

As part of our mission to inspire health, wholeness and hope, we support community programs that focus on medical care, education, health screenings, and other community initiatives. We invest in our communities to improve the quality of life for current and future residents. Sponsorships are tied to the high-priority areas outlined in our Community Health Needs Assessments, including: mental and behavioral health, financial stability, food security, and access to care. Please submit this form at least 45 days ahead of your event or deadline. We request a minimum 45-day notice to allow for appropriate planning and resources should your request be approved. For sponsorship questions or concerns for Kern County, please email Matt Cauthron at CauthrM@ah.org. For sponsorship questions or concerns for Kings, Tulare, Fresno, or Madera counties, please email Valeria Guerrero at AlvareVF@ah.org.
Sponsorship type*

Annual PartnershipSingle EventIn Kind DonationMobile Unit
I am requesting the mobile clinic for the following services:*

Point of Care ServicesA1CHemoglobinGlucoseUrinalysisPregnancy testWeight / HeightBlood pressure / PulseVaccinationsCOVID-19 VaccinesPfizer adult (1st, 2nd + booster)Pfizer kids (1st + 2nd)Moderna (1st, 2nd + booster)Health EducationDiabetesHypertensionNutritionMedicationCOVIDPre-natalOther
Focus area*

Access to CareFinancial StabilityMental and Behavioral HealthFood SecurityOther
Geographical target area
Please be as specific as possible
Region*

BakersfieldDelanoTehachapiHanfordTulareSelmaReedleyVisaliaOther
Event Address*

Street Address

Street Address Line 2

CityState

Zip Code
County*
County name
Event date*

MonthDayYear
Date
Event start time*

:HourMinutesAM/PM Option
Event end time*

:HourMinutesAM/PM Option
Event name*
Name of event
Total attendees
Total number of attendees
Event age range
Zip code(s)
Requested sponsorship amount*
In-kind request
Event information
Where will sponsored funds go to:*
Explain how does the work of your organization align with Adventist Health’s mission and focus areas listed above*
Will this sponsorship request include events and activities?

YesNo
Please describe any events and activities that will be included
Does this sponsorship request include requests for Adventist Health to provide goods or services, like education, health screenings or in kind donations?

YesNo
Are you requesting mobile care at this event?*

YesNo
Please describe any goods or services that Adventist Health would be expected to provide*
Have we sponsored previously?

YesNo
Please upload any event fliers, sponsorship request documents

Browse Files

Cancelof
Organization Name*
Name of Applicant*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Organizational Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please verify that you are human*
By providing your details and clicking "Submit" you agree to:
- Receive communications from Adventist Health through email, SMS, text, or calls by an automated telephone dialing system for the purpose of Adventist Health maintaining its relationship with you and providing you information related to services you may be interested in.
- Adventist Health collecting and disclosing to third parties personal information and communications for the purpose of fulfilling your inquiries or requests for services or information.
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