Donation/Sponsorship Request

Sponsorship Request Form

Before proceeding, all sponsorship and donation requests must be submitted at least 90 days prior to the start of the event/project.
Organization Information
Legal Name of Organization Applying*
Should be the same as on IRS determination letter and as supplied on IRS form 990
Tax Identification Number*
Tax Exempt Certificate*
In order to receive a donation or sponsorship, the organization must be a nonprofit and charitable organization. Please provide a copy of your 501(c)(3) Federal Tax Exempt Certificate.
Accepted file types: pdf.
Organization W9*
Please provide a copy of your organizations W9.
Accepted file types: pdf.
Year Founded*
Current Annual Operating Budget*
Are you currently receiving funding from other entities?*
If yes, please identify the top three sources and the amount.*
Source Amount
Contact Information
Executive Director/Primary Point of Contact*
First Last
Email Address*
Enter Email Confirm Email
Primary/Administrative Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Fax Number
Project Information
Project Name*
Purpose of the Grant*
Beginning of the Project/Campaign*
Date Format: MM slash DD slash YYYY
Ending of the Project/Campaign*
Date Format: MM slash DD slash YYYY
Amount requested.*
Total project cost.*
Geographic Area Served.*
Targeted Demographic.*
How will LECOM be recognized as a sponsor of this project/event?*
Are there additional opportunities to incorporate LECOM into this event (e.g. brochure distribution, on-site presence, vendor tent, etc.)*
Please upload any supporting documentation.
Files must be in PDF format. Maximum allowable size per files is 2MB.
Drop files here or

Accepted file types: pdf.
Consent*
By checking this box, I confirm that the information I entered is accurate and truthful. I agree that by filling out this form, it does not guarantee a sponsorship or donation from the Lake Erie College of Osteopathic Medicine or any of its affiliates.
I agree.
Phone
This field is for validation purposes and should be left unchanged.

Source	Amount

Donation/Sponsorship Request

Sponsorship Request Form

Before proceeding, all sponsorship and donation requests must be submitted at least 90 days prior to the start of the event/project.

Organization Information

Contact Information

Project Information