Sponsorships and DonationsRequest Form

Sponsorships and Donations

Request Form

Request and Approval Process:

Ideally, sponsorship and donation requests should be made as early as possible, but at least 60 days prior to the event or funding deadline.
Submissions are received and evaluated on a monthly basis by Hartford HealthCare’s Sponsorships for Social Impact Committee.
Requests will be responded to within 45 days.
If your request is approved, you will be contacted with the funding level and expectations of use of Hartford HealthCare name and/or logo.

NOTE: Due to the number of requests and limited availability of funds, a request may be denied even if it meets funding criteria.

Name of Organization*

Description of Request

Name of Event or Sponsorship*

My donation or sponsorship relates to one of the following Hartford HealthCare priorities:*

Promotes healthy lifestyles and behaviors, especially nutrition or physical activity

Reduces the burdens of chronic disease, especially diabetes or congestive heart failure

Addresses health inequities or social influencers of health, especially food insecurity, income sufficiency, safety, and healthy housing

Enhances community-based behavioral health services and mental wellness

Other

Summary of Request*

Please be sure to share specifics how this request would address the Hartford HealthCare priorities of Access, Affordability, Equity and/or Excellence

Amount Requested*

Sponsorship History*

Have you been sponsored by Hartford HealthCare in the past?

Select or enter value

Date of Event (if applicable)

Additional Materials

Please attach any sponsorship paperwork.

Drag and drop files here or

Contact Information

First Name*

Last Name*

Email*

Phone*

Phone

Address*

City*

Zip*

Send me a copy of my responses

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