* 1. Organization Name

* 2. Event Name

* 3. Date, Time, & Place of Event

* 4. Amount of Desired Sponsorship

* 5. Is the program/event solely provided for marketing purposes?

* 6. Does the program/event directly benefit the vulnerable/low income population?

* 7. Does the program/event address an identified community need? Select all that apply:

* 8. Briefly describe the health need(s) your program/event will address and how:

* 9. Organization's Sponsorship Deadline

Date

* 10. Please select one:

* 11. Is this your first time requesting sponsorship from Renown Health and Hometown Health?

* 12. Have you received funds from us before?

* 13. Please attach a W-9 Form

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* 14. What is your information?

* 15. Are you a 501(C)(3)?

* 16. Please attach the 501 (C)(3) Letter

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* 17. Please attach the Description of Organization

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* 18. Please attach the Sponsorship Packet

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