Sponsorship Request Form
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Pick Organization Country and Type
Organization Search

Organization Info
Please fill out any missing organization information below.
If you know the Tax ID it will speed up the processing and verification of your request.
(Providing a contact at the organization will speed up the processing of your request.)
Requester Primary Contact Information
(this will be in the email used to communicate the status of the request moving forward. please verify the email)
Event Details
(include Street, City, State and Postal Code)
Donation Request Form

Range of Sponsorship Levels Available: e.g. $500 - $5,000*

Event Information
Time of Event*
Event Start TimeEvent End Time
Parish Where the Event is Taking Place:*

Event Website:
Event mission/purpose*
How many years has Peoples Health participated in this event?*
What was Peoples Health’s contribution to this event last year, if applicable?
What are the anticipated demographics?*
What percentage of attendees would you expect to be Medicare eligible?*
i.e., those over the age of 65 and/or those on disability
What was the attendance for this event last year?*
Who are some other sponsors of this event this year?*Please make a note if you are listing last year`s sponsors.
List any other events Peoples Health supported last year that were hosted by your organization.
If so, what dollar amount did Peoples Health contribute to those events?
Event NameAmount Contributed
Please list any deadlines and their date(s). e.g. Print Deadline
Deadline NameDeadline Date
The following items must be uploaded:
1. Request Letter
2. Sponsorship Levels Available and the Benefits for Each Level
3. Organization Description
4. W-9 Form

(Click on Select button to attach multiple documents. The files should be selected from a folder on your computer. The files will be listed under the attachment box. Files will be uploaded when you click submit. Attachments must be in one (1) of the following formats: Pdf, doc, docx, xls, xlsx. Limit the file size to less than 10MB.)

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Please click the Submit Form button only once, to avoid multiple transactions/donation requests.
* Denotes required fields
A DonationXchange account will be created and provided in the confirmation email for tracking purposes.

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