Charitable Contribution / Event Sponsorship Application CompanyThis field is for validation purposes and should be left unchanged.Project / Event Title(Required)Estimated Number of Attendees(Required)If it is an event, enter the event dateOrganization Name(Required)Organization Contact Person (Full Name)(Required)Email Address(Required) Phone Number(Required)Website Mailing address for a checkWhat type of donation are you seeking?(Required) Monetary In-Kind Donation Requested Amount($)(Required)In-Kind Donation Request (e.g. goods, services, etc. )(Required)Has Stoughton Health previously donated to this organization?(Required) Yes No Unknown Previous Donation Amount ($) OR Goods/Services Donated(Required)Previous Donation Date(Required) MM slash DD slash YYYY Have you requested funds from any other organization(s)?(Required) Yes No Name of Organization(s)(Required)Briefly describe how the funds will specifically be used.(Required)Will Stoughton Health receive recognition? If yes, do you need our logo or other marketing materials?(Required)Deadline for logo/ad submission(Required) MM slash DD slash YYYY The proposed event/project aligns with which of Stoughton Health's priorities? (Select all that apply)(Required) Chronic Conditions Injury and Safety Mental Health and Substance Use Which age group(s) would benefit most from this donation? (Select all that apply)(Required) Infants/Children Teens Adults Senior Citizens Briefly describe how the proposed project/event aligns with the selected priorities.(Required)How will Stoughton Health's partnership positively impact the community?(Required)Do you agree to send photos and/or stories that Stoughton Health could use for social media, marketing, community benefit stories, etc.?(Required) Yes No Upload Files Drop files here or Select files Accepted file types: jpg, gif, png, pdf, xls, xlsx, csv, doc, docx, txt, Max. file size: 50 MB, Max. files: 10. CAPTCHA
