Salem Hospital: Sponsorships: Request for Funding Form

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Sponsorship request for funding form

If you would like Salem Hospital to consider a request for sponsorship, donation, event participation or contribution, please submit your request by using the sponsorship request form below.

Please fill out the form below. Click the Send Message button at the bottom of the screen when finished.

Event Information
Date of request :
Event/Sponsorship:
Amount or in-kind contribution requested:

Requestors information
Name:
Mailing address:
Telephone number:
Email Address:

Event details

Parameters for involvement
For example, day-of-event involvement, giveaways provided at event, other related marketing needs.

Project description
Briefly describe the sponsorship or in-kind donation, how the funds will be used, how it supports the priorities identified in the sponsorship guidelines, etc.

Comments
Other comments which may be helpful to the Cabinet Planning Committee in considering your request:

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