2025 Northwest Wisconsin Sponsorship Form

2025 Northwest Wisconsin

Sponsorship Form

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Mayo Clinic and Mayo Clinic Health System are committed to giving back to the community. All fund-seekers are asked to provide answers to required questions (as noted with an *). An up-to-date W9 is required. Please ensure the name and address match the organization and address in the application.

Please keep your answers on this form as brief as possible. You may also attach additional information about your application at the end of the form. Applicants are asked to answer the required questions at a minimum.

Name of Requesting Organization*

State the name of the program/project/event or sponsorship package for which this request is being made.*

Date of Activity/Event*

If the request if for a specific event, please list the date.

Event time

If applicable

Event location

If applicable

If you are requesting an event sponsorship, are volunteers needed at your event? If so, how many volunteers?

Please provide description of volunteer activities.

Brief Summary*

Briefly explain the request.

Amount Requested*

Sponsor Role and Recognition

Select

Previous Support

Check the box if this event/activity/organization has received money from Mayo Clinic in the past.

Community

Please indicate the community served.

Select

Social Determinants of Health

Select or enter value

Impact

Describe the impact the proposal will have in the community.

Does your proposal address a Community Health Need?*

If so, please select the PRIMARY need addressed. If no, please select N/A.

Select

Audience*

Please indicate if any of the audiences below are served by this request. Select Other if multiple apply.

Select or enter value

Approximate Impact*

Please indicate the number (approximate) of individuals impacted by this request (program beneficiaries).

Additional Information

Please provide additional information, as needed.

Contact Information

Please include complete contact information. Remember, the name of the organization and the address listed below must match the W9.

Tax Identification Number of the Requesting Organization*

Indicate the Tax Identification Number of the requesting organization. This number must match the W9 or the fiscal agent for the request to whom funds will be distributed.

Name*

Title

Address*

City*

State*

Zip*

email*

phone*

website

Deadline for a response (if necessary)

We will do our best to review this in a timely fashion. Please let us know below if you have a deadline to be notified of the funding decision.

By checking this box, I acknowledge that if funded, my organization will be required to submit an acknowledgment letter of funding within 15 days of receipt of funding*

File Upload*

Please upload a W9, proposal budget and any additional information you would like to share. If you have a recent project report from a previous award, please include that.

Drag and drop files here or

Send me a copy of my responses

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