Community Support Requests

Thank you for reaching out to Memorial Health.


This form is for community groups and organizations requesting support from Memorial Health (sponsorships, cash donations, supplies, meeting space, presenters, etc.).


NOTE: Required fields are marked with a red *


If you have questions or need assistance, please email CommunityHealth@mhsil.com

Tell us about your organization

Is this is a tax-exempt organization?
Phone
Please select your affiliate hospital.*

Tell us about your request


Examples of things to share with us:


  • Purpose/Goals
  • Target audience
  • Expected attendance
  • Topics requested for speakers
  • History of event
  • Event date/location/start and end times
  • Recognition or tickets included in the sponsorship
  • Anything else that would be helpful in reviewing this request


NOTE: There is an opportunity below to attach supporting documents.

If you are not requesting funding, please enter "0".

Tell us about Memorial's past support

Has Memorial supported this request in the past?

Include funding amounts and/or a description of past support. Please provide the name of any involved Memorial Health colleagues.

Please upload program fliers or supporting documents here.

Drag and drop files here or

Thank you for reaching out to Memorial Health.

We will respond to your request as quickly as possible.

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