Mission Based Initiatives Application

As part of our mission to create healthier communities, CHI Franciscan Health supports the charitable efforts of a number of organizations through our Sponsorship Program. All sponsorship requests must be submitted in writing, and must be accompanied by this application form. Please reference the CHI Franciscan Health Sponsorship Guidelines to review our criteria for sponsorship.


  Organization Details
   
  Date *:

 
Jump to documents
   
  Name of organization *:
Date founded:

 
     
 Address:
Telephone:

 
Fax:

 
     
  CEO/President *:
 
   
  Purpose/mission of organization:
   
  Tax-exempt status (please check one) *:


   
  List of organization's Board of Directors and each director's business affiliation(s):
   

  Request Details
   
  Request is for (please check one) *:


   
  Mission Category (please check one) *:



   
  Detailed description of the amount or type of support requested:
   
  Brief description of the purpose for the sponsorship, including the project or event's objectives, its need among the intended audience/community, expected attendance and a plan for measurement and evaluation of results:
   
  Please list estimated number that will be served by your program:
   
  Please list any available sponsorship levels and benefits:
   
  Date contribution is needed and/or date of relevant event:

 
   
  List of other major project contributors and funding levels:
   
  Has a request for program funding been made to any other Franciscan hospital, clinic or department? If so, please list:
   

  Additional Information
   
  Additional information related to your request may be submitted in addition to your application form. Please list additional items for submission here:
   

  Attach documents (if any):
     
  Maximum allowed size is 5 MB per file. Allowed document types are JPG, DOC, DOCX and PDF.
     
 
 
 
 
 
   

Submitted by:
Submitter's email:

CHI Franciscan Health includes St. Joseph Medical Center, Tacoma; St. Francis Hospital, Federal Way; St. Clare Hospital, Lakewood; St. Elizabeth Hospital, Enumclaw; St. Anthony Hospital, Gig Harbor; Highline Medical Center, Burien: Harrison Medical Center and Harrison HealthPartners, Kitsap and Olympic peninsulas; Franciscan Hospice House, University Place; Franciscan Medical Group clinics and providers, Pierce, King and Kitsap counties and the Franciscan Foundation.