Online Funding Request
Please complete this form in order to place your request.
Requests up to $1000 are reviewed bi-weekly.
Requests exceeding $1000 are reviewed quarterly, on the fourth Wednesday of January, April, July, and October. Requests must be submitted prior to the first day of the quarter to be considered at that quarter's meeting.
Federal Tax ID
Contact Name & Title
Contact Phone Number
Contact Email Address
Address (Street, City, State, Zip)
Name of Event/Cause:
If an event, address or location where event will take place
Date of Event (if applicable)
Amount Requested. If various sponsorship levels are available, please attach to the request.
This request is what percentage of total expenses?
Reply Deadline (if applicable)
Health [general health & wellness]
Chronic Disease & Contributing Factors
Mental Health & Substance Abuse
Healthy Food & Food Access
Community Building [childcare, education, housing, income, transportation]
Please describe your request in detail.
Specifically, how will the money be spent?
Other funding sources (committed and pending):
Who is your audience?
How many people will be reached?
Who will benefit from this effort?
Describe Mayo's past involvement:
How will Mayo be recognized?
List Mayo Clinc Health System employees involved:
Please attach W-9 and sponsorship levels, if applicable.
Anything we missed...let us know!
Send me a copy of my responses
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