Corporate Citizenship Request Form

To request funding from Delta Dental, please complete the form below and attach all supporting documents.


Please Note:

  • We are pleased to review your request for support from eligible organizations whose mission aligns with our areas of focus.
  • Funding requests are accepted and reviewed on a rolling basis.
  • Decisions are typically communicated 4 – 8 weeks after submission.
  • Funding is limited to one grant per nonprofit organization per calendar year. If additional funding is required in a new calendar year, a new application must be submitted.


For more information about our Corporate Citizenship programs and initiatives, please contact corporatecitzenship@deltadentalmass.com

 

Request for funding, event Sponsorships or In - kind donation

 
 
 
 
mm/dd/yyyy
 

Please include the street, city, state and zip code

 
 
 

Contact Information

 
 
 
Phone
 
 

Overview of Request

 

Please provide a brief description of your organization and program.

 
 

Select all that apply

 
 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 

If having issues uploading material, please send to corporatecitizenship@deltadentalmass.com

Drop your files here
 
 
 
 

Be sure to enter a dollar amount. If requesting in - kind donation or event sponsorship, please put N/A

 
 
 

If so, please indicate years(s) and amount of the past three sponsorships.

 
 

if so, please specify logo requirements.

 
 
 
 
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