Application for Sponsorship

	Tell us about your organization

	Contact Name*

	Contact Phone Number*

	Contact Email*

	Organization Name*

	Organization Street Address*

	City*

	State*

	Zip Code*

	Country*

	Organization Website URL*

	Organization Mission Statement*

	What is your organization’s cost to raise a dollar?*

	To your knowledge do any of your board members work at Providence or their affiliates?*
	Yes No

	If Yes enter name

We fund specific programmatic areas that align with our mission and strategic priorities. Please choose the program area that best describes this sponsorship opportunity:

Housing Instability/Homelessness, Mental Health/Substance Use Disorders, Access to Health Care, Health Equity/Racism/Discrimination.*

	Housing Instability/Homelessness
	Mental Health/Substance Use Disorders
	Access to Health Care
	Health Equity/Racism/Discrimination

Are you asking for funding for a program or for an event?*

	Program
	Event

	Name and description of sponsorship opportunity*

	If event: Date of event*

	Estimated number of attendees*

	Location of event (in-person, virtual, or both)*

	Demographics of audience for event*

	List other sponsors (including title sponsor, if applicable) and partners*

	Additional information

	Why should Providence sponsor this event?*

	How will sponsorship dollars be used?*

	Please list all levels of sponsorships opportunities and their associated benefits*

	Level of support requested* Please list dollar amount

	How will you communicate this sponsorship internally and externally to others including ad placement, email, social media, web, radio, and others?*

	Is an ad included in this sponsorship?*
	Yes No

	How will you report to us on the success of the proposed sponsorship?*

	Are there other ways to participate in this event? (volunteering, information booth, swag bag/branded gift, guest speaker, etc.)

	What is the deadline for sponsorship decision?*