Application for PeaceHealth Sponsorship - Longview
PeaceHealth is committed to positively influencing our community and fostering the health and wellness of our neighbors. We welcome requests for support from local not-for-profit organizations whose missions and strategic goals align with ours.
Please consider the following guidelines when submitting an application for sponsorship:
• We ask that you please submit your request at least six months prior to your deadline for print, rather than the actual event.
• One request per organization per year.
• We are unable to accommodate requests from individuals, for-profit companies, or organizations outside of our service area.
For questions, please contact Debra Carnes, director of strategic communications and engagement for PeaceHealth's Columbia network - email@example.com.
Fill in the information below. Use the scroll bar on the right to move down the page. When finished, click the
button located at the bottom of the form.
Questions marked with a
require a response.
Please note that all requests must be submitted AT LEAST SIX MONTHS PRIOR to your printed collateral deadline.
1. Date of request:
2. Printed collateral deadline:
3. Name of organization:
4. Mailing address:
5. Contact person:
6. Phone number:
7. Email address:
8. Short description of your organization's mission:
9. Name of event/activity/program:
10. Date of event/activity/program:
11. Location of event/activity/program:
12. Dollar amount or description of non-financial support requested:
13. Geographic area served (i.e. Cowlitz County, city of Longview):
14. Approximate number of people served or involved in event/activity:
15. Describe how this event/activity/program ties in with improving personal and/or community health and wellness:
16. Is there a fee for participants? If so, how much? Will there be scholarships available to low income individuals for whom the fee is a barrier to participation?
17. Would the sponsorship include a table at the event or PeaceHealth participation in some other form? If yes, please give details.
18. How would the sponsorship be acknowledged?
19. How will you measure success?
20. Can you commit to providing a follow-up report summarizing the event/activity/program outcomes that also includes a participant's story?
21. Will you be emailing supplementary materials?
22. Besides sponsorship, are there other ways that PeaceHealth can partner with you through your programs and services?
If you would like a copy of this completed form, please enter your email address.