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608.348.2331
Search
Find A Doctor
Search Providers
View All Providers
Southwest Health Clinics
About
Visiting Southwest Health
Leadership Team
Board of Directors
Vision and Values
History
Quality and Pricing
Paying for Your Services – Patient Financial Info
Awards & Recognitions
Community Health Needs
Nondiscrimination Statement
Our Services
COVID19 UPDATES & INFO
Audiology
Cancer Care
Dermatology
Diabetes Education
The EDGE
EMS
Epione Pavilion
Eye Center
Emergency & Urgent Care
Financial Assistance
General Surgery
Health Information
Laboratory
Mammography
Massage Therapy
Medical Imaging
Mental Health
Nutrition Counseling
Orthopedic Institute
Otolaryngology / ENT
Pain Management
Patient Financial Services
Pediatrics
Pregnancy
Pharmacy
Primary Care Clinics
Rehabilitation & Therapy
Senior Care
Sexual Assault Support
Sleep Lab
Specialist Clinics
Speech Therapy
Swing Bed Program
Women’s Center
My Healthy Life
Life Apart. Healthy Together.
The COVID Vaccine
COVID19 UPDATES & INFO
Say It Out Loud! Art Contest
Class Schedules
Programs & Events
Cancer Support Group
100 Mile Challenge
Sole Mates Walking Club
Know Your Numbers
Depression Screen for Adults
Activity
Food & Eating
Minds
Preventive
Work
Young at Heart
Media
Gallery of Gratitude
Videos
News
Heart 2 Heart
Community Engagement
Social Media
Advertising
Sponsorships & Donations
Giving
About the Foundation
Donate Online
Employees That Care (ETC)
Projects & Events
Scholarships
Moments of Impact
Volunteer
Ways to Give
Careers
Apply Online
Career Opportunities
Physicians
Volunteer
Student Experiences
Survey
Forms
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Baby Gallery
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Sponsorship / Donation Request Form
Sponsorship / Donation Request Form
Organization Details
Company/Organization Name
Name
*
First
Last
Phone
*
Email
*
Is your organization tax exempt?
*
Yes
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Tax ID Number
Our vision is creating a healthier southwest Wisconsin, and our top criteria for supporting programs is whether it provides a DIRECT health benefit. Describe how your organization or this program addresses community health needs in southwest Wisconsin.
*
Event / Project Details
Name of Event/Project
Date of Event/Project
Date Format: MM slash DD slash YYYY
Location of Event/Project
Please include the address details of the event/project below.
Street Address
City
State / Province / Region
ZIP / Postal Code
Description of Event/Project
Describe in detail the nature of your event or sponsorship/donation request
Projected attendance at event/project?
How many years has this taken place?
Attendance last time?
What percent of the funds raised will directly benefit people in southwest Wisconsin? Also what percent is used for administrative expenses?
Response Deadline
Date Format: MM slash DD slash YYYY
Sponsorship Details (if applicable)
Cost of Sponsorship
If available, what are sponsorship levels and associated benefits?
Level
Cost
Benefit
Describe the sponsor opportunity connected with your event/project?
Are there any other reasons this organization/program/event should receive funding?
Make donation or sponsorship check payable to:
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Address to send check:
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Event/Project Documents
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Acknowledgment
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Please review our sponsorship/donation policy above before submitting this form. After you click "Submit" you will receive an automatic email to the address you listed.
I have read and I understand the guidelines, policies and approval process.
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