Community Sponsorship Application

Please carefully review our policies, guidelines and deadlines before submitting your application.

* Required Fields

Name of organization *

Year established *

Address *

Sponsorship contact name and title *

Sponsorship Contact Phone *

Sponsorship Contact Email *

Nature of services provided by organization *

Geographic areas served *

Name of event/activity *

Date of event/activity *

Location of event/activity *

Event/activity target audience *

Expected attendance *

Type of sponsorship request *

In-Kind

Donation Labor/Volunteer Hours

Event/Activity Sponsorship

Other

If "other," please describe

Requested amount (dollars/hours) *

Date funds/services required *

Please describe other sources of support for this event/activity that you've already received or are pursuing. *

Tell us about the event and how it connects to your organization's mission. *

Tell us how your event supports CoxHealth's mission, vision and values. *
Mission: To improve the health of the communities we serve through quality health care, education and research. Vision: To be the best for those who need us. Values: Safety, compassion, respect and integrity

How will CoxHealth's contribution be used? *
What's the community benefit, and how will you determine whether your event or project accomplished its goal?

Is there any additional information you'd like to provide about this sponsorship opportunity?

What media/signage/public exposure is included as a part of the sponsorship? *

What are your administrative costs for this event? *

What is your fundraising goal? *

What other ways could CoxHealth support your request? *
Ex.: Ambulance, booths, medical, staff educators, etc.

What other sponsorship levels are available? *

Is there an opportunity to be the exclusive healthcare sponsor? *

Additional Information
If you’d like to include additional information with your application, such as a breakdown of available sponsorship levels or more information about your activity, organization or event, please attach that document here. (.PDF, .DOC OR . JPG)

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