Supplier DiversityRegistration Form

Supplier Diversity

Registration Form

Stanford Medicine is committed to supporting diverse growth and development in the communities we serve. To achieve this, we have a formal supplier diversity program focused solely on pursuing these opportunities.

We are eager to cultivate relationships with women, minority, veteran, disabled and LGBT business enterprises providing products and solutions that meet our quality standards, competitive pricing, and service requirements.

To demonstrate your interest in providing products, services, or solutions to Stanford Medicine, please complete this form with the following information:

General Company Information
Demographic Information
Commodity Codes
Diversity Certification Information

Completing this form does not guarantee a contract opportunity with Stanford Medicine. Your profile will remain active for one year.

Supplier Diversity Registration Questions?

For general questions about the supplier diversity registration process, your profile, or doing business with Stanford Medicine, please contact us at SupplierDiversity@stanfordhealthcare.org.

Todays Date*

Vendor Name*

Doing Business As

Company Website*

www.companyname.com

Address

City*

State*

Select or enter value

Postal Code*

Primary Contact (First, Last Name)*

Primary Contact Title*

Primary Contact Email*

Primary Contact Phone Number*

Phone

Company Overview Description*

Provide brief description: 3 line maximum.

Products & Services Description*

Provide brief description: 3 line maximum.

Commodity Codes*

Select or enter value

Market Reach*

Select

Woman Owned*

Select

Primary Minority Indicator*

Select

Diverse Business Classification*

Select

Certification Expiration Date

Certification Upload (relevant files, i.e., capabilities statement)

Drag and drop files here or

How did you hear about Stanford Health Care?*

Select

If OTHER, please indicate where.

Send me a copy of my responses

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