Community Support Sponsorship Program

Transcription

1 Community Support Sponsorship Program Please submit completed applications (.doc or.pdf file) to:

2 HENDRICKS REGIONAL HEALTH Community Support Sponsorship Application Applicants should read and follow the instructions carefully to avoid delays, misunderstandings, and the possible return of an application. Hendricks Regional Health may reject an application if it fails to adhere to these requirements. PURPOSE The Community Support Sponsorship was established to help strengthen our community by improving the quality of life for the individuals served by Hendricks Regional Health. This program will fund publicly supported, tax-exempt nonprofit agencies, programs and organizations that directly compliment the mission and vision of Hendricks Regional Health. We often practice random acts of kindness, but believe that a systematic approach is best for providing ongoing support for community health. The following describes our sponsorship guidelines as well as our review and approval process of all requests. SPONSORSHIP Typical sponsorships range from $100 to $5000. Please submit your request six (6) weeks before any promotion/advertising of your event is expected to begin. Sponsorship Guidelines Consideration for sponsorships will be dependent on the following: 1. Support of health and wellness to benefit the health of our community 2. Alignment with our mission, vision, core values and strategic priorities 3. Hendricks Regional Health's brand awareness and/or health education messages to target audience(s) Preference will be given to those requests that satisfy the following: 1. Health screenings / preventive offerings to target audience(s) 2. Promotional value to Hendricks Regional Health Organizations may submit only ONE sponsorship application per year, which may include a request for more than one purpose. We understand there may be exceptions from time- to- time. 2

3 Sponsorship funding is NOT available for: Capital campaigns Deficit financing Fireworks displays Advertising Membership fees or association fees, either personal or corporate Individuals for participation in trips, tours, workshops, contests or competitions Individual sports teams (entire leagues are acceptable) Political campaigns, candidates, parties or partisan activities Fraternal, church or labor groups Family foundations Projects/programs outside of Hendricks County, our primary service area Projects/programs already completed APPLICATION PROCESS Applications are accepted throughout the year, although organizations may receive funding only once per calendar year, with limited exceptions. Applications may be made by only and applications must be typed. You may download the application at Applicants will be notified in a timely manner as to the outcome of their sponsorship application. Hendricks Regional Health reserves the right to partially fund any sponsorship request. The following information is required for a complete application package. Application Cover Sheet (See page 6) Detailed Budget Worksheet (See page 7) Budget Narrative, if necessary Project Narrative (See page 5) Attachments: A. Federal Tax Exempt 501(c)(3) Letter B. Current Fiscal Year Budget C. Most Recent Audited Financial Statement * D. Annual report, if applicable E. A list of the current Board of Directors and their affiliations F. Letters of support (maximum of 5) are not required, but are strongly suggested *If an audited financial statement is not available, please indicate and furnish your internal financial report. 3

4 APPLICATION EVALUATION Our selection committee considers the following factors when reviewing sponsorship applications: Eligibility 501(c)(3) letter of verification The need addressed in the proposal The potential benefits of the project to the community The capability of the proposing organization to achieve the desired results Evidence of cooperation with other organizations in the same field, or organizations assisting with or supporting the project The extent and sources of other funds being sought and/or raised for the project YOUR RESPONSIBILITY AS A SPONSORSHIP RECIPIENT Sponsorship recipients must comply with the following requirements: Use funds only for the approved project All advertising, printed materials, on-air promotions, presentations, etc. are required to recognize Hendricks Regional Health. Any representation or mention of HRH must receive pre-approval from the Hendricks Regional Health. Recipients will be provided with appropriate logos upon request. Please do not pull the logo from our website, as it is not print quality. Please receive preapproval by submitting these elements to clwildm@hendricks.org. Submit a report to Hendricks Regional Health within 90 days of project completion that includes data regarding the results of your program/project/event. This report must include a financial accounting of expenditures (including copies of invoices), all print advertisement (actual newspaper, flyer, etc. not a copy), and copies of all final brochures or programs. *Recipients who do not comply will not be considered for future sponsorship for a period of time to be determined by Hendricks Regional Health. 4

5 Community Support Sponsorship Application Organizational Information Name of Applicant Organization Hendricks Regional Health Community Support Sponsorship 1000 East Main Street Danville, IN Phone: (317) Fax: (317) Federal Tax I.D. Number Mailing Address City State Zip Phone Fax Website Address (if applicable) Applicant Information Ex CEO or Executive Director Name Phone Phone Contact Name (if different from CEO/Executive Director) Title Phone Program/Project Information Program/Project Title Targeted Geographic Area to be Served Anticipated Number of People to be Served Area of Concentration (indicate only one) Health, Wellness and Prevention Sports/School-Related Date and Duration of Project Community Event Other Program/Project Budget Information Total Amount Required for Project Total Amount Requested From Hendricks Regional Health $ $ Signature and Certification I, the undersigned, certify that the statements herein are true and completed to the best of my knowledge. I agree to comply with all policies, terms, and conditions of Hendricks Regional Health. CEO/Executive Director Date 5

6 Hendricks Regional Health Community Support Sponsorship Project/Program Budget Worksheet Applicant Organization: Please list total funding and expenses related to this project. HRH Sponsorship Funds Internal Funds Other Sources Confirmed Other Sources Projected Total Program Revenue $ $ $ $ $ Program Expenditures Personnel Advertisement Consultants Equipment Supplies Other (please specify) Total $ $ $ $ $ 6

7 PROJECT NARRATIVE In three pages or less, please include the following: Introduction Describe your organization s background, mission and purpose. Schools (including parent/teacher organizations) should include a letter from the principal and/or superintendent supporting the project. Statement of Need Explain the need that prompted this project. Please include details regarding the population, geographic area, and the impact your project will have on our community. Project Plan Description Briefly summarize the project and how it will address the statement of need. Include the objectives of the project, anticipated benefits, project staffing, management, implementation process and time frame. Evaluation Describe the method that will be used to determine and measure the project s success. The evaluation component must be specific, meaningful, measureable and realistic/achievable. Include goals, evaluation methods and anticipated goals/outcomes. Community Support What are the project s other potential or confirmed sources of support? What other organizations are partnering with yours on this project? Comments Comments on past or present attempts and/or projects to address the designated need. COMMUNITY SUPPORT SPONSORSHIP CONTACT INFORMATION Lori Wildman Marketing Outreach Specialist Hendricks Regional Health Phone: (317) clwildm@hendricks.org 7