Donation/Sponsorship Request

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?*

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*

Ending of the Project/Campaign*

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, 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.

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

Are You Ready?