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Sponsorship Request Application

Investing and Partnering for the Future

We realize no agency can effectively confront all community issues alone. That’s why we seek promising partnerships with hundreds of service and social organizations that reach out to families and individuals in need.

Sponsorship and contribution requests

Though we admire all worthy projects, we receive far more requests than we can grant. Given the volume of important causes, we believe it’s essential to have clear, meaningful guidelines for evaluating requests in accordance with our mission, and those of our partners, priorities for giving, geographical locations and budget capacity.

To be eligible, your organization must offer one of the following:

  • Programs that benefit communities living with or affected by HIV in our service areas
  • Programs that provide food, shelter, health care or basic services for the living with or affected by HIV
  • Projects that satisfy unmet needs in the community without duplicating other HIV programs or services
  • Initiatives that are in line with CAN Community Health’s mission, vision and values

All organizations must have:

  • 501(c)(3) tax-exempt status
  • Programs requests that clearly define and measure goals

 

1. All requests for contributions must be submitted using the form below.
2. It is not necessary for organizations to follow up about the status of their applications. All organizations will receive confirmation after funding decisions have been made.
3. Organizations receiving gifts of $1,000 or more are required to submit a progress report following the completion of the program or activity.
4. Sponsorships are granted for one year unless otherwise specified, and recipients are responsible for requesting renewed support. Each request will be considered anew and compared with other requests received for that year.

ORGANIZATION INFORMATION

Organization Name-Legal Name (required)

Federal Taxpayer ID Number (required)

Tax Status (required)

For-ProfitGovernmental501(3)(c)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Year Founded (required)

Mission Statement (required)

Number of people served annually (required)

Website or URL (if available)

Executive Director (if applicable)

Project Contact (required)

Contact Email (required)

EVENT/PROJECT INFORMATION

Project/Event Name (required)

Phone Number (required)

Date Funds and/or Services are Needed (required)

Is this a first-time program/event or annual? (required)

YesNo

Event date, time and location (if applicable)

Describe the sponsorship level requested-dollar amount (required)

Has CAN Community Health provided a sponsorship to your organization in the past?

YesNo

If so, provide the date of the event, level of sponsorship and outcome:

What sponsor benefits will be provided? (Mark all that apply)

BannerBooth/TableComplimentary ticketsLogo in adOther

If "Other" please describe:

If this request is granted, list any goods or services that CAN Community Health and/or its team members will receive (i.e. dinner tickets, advertisements, etc). Please include monetary value for tax reporting purposes.

Project Description

Using 2-3 sentences, describe your project – including the benefits of the project, length of time for the project to be completed, budget, other sources of income, etc. If requesting in-kind services, please provide detailed description of services requested. (required)

Project Mission

How will your project help to improve the health of residents in our region? (required)

How does this request support the mission of CAN Community Health? (required)

Beneficiary

Identify the individuals or groups that will benefit from the requested contribution/sponsorship. Include location/county served and the anticipated number of individuals that will benefit or receive services as a result of the project. (required)

Whom will the contribution/sponsorship benefit? (required)

Project Goals and Outcomes

What will the project accomplish? How will you measure success at accomplishing stated goals? (required)

DOCUMENTATION

Current W9 (required)

501c3 verification (if applicable)

Please upload supporting document (if applicable)