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Donation/Sponsorship Request
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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, Max. file size: 2 MB.
Organization W9
*
Please provide a copy of your organizations W9.
Accepted file types: pdf, Max. file size: 2 MB.
Year Founded
*
Current Annual Operating Budget
*
Are you currently receiving funding from other entities?
*
Yes
No
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone Number
*
Fax Number
Project Information
Project Name
*
Purpose of the Grant
*
Beginning of the Project/Campaign
*
MM slash DD slash YYYY
Ending of the Project/Campaign
*
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
Select files
Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.
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.
Email
This field is for validation purposes and should be left unchanged.
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