Community Sponsorship Request

Submission Requirement

Community sponsorship request applications must be submitted a minimum of 45 days prior to the date of the event or program.

Applications submitted less than 45 days prior to the event date are not guaranteed to be processed and/or paid (if approved) by the date of the event.

Submission Requirement Acknowledgement:

I acknowledge I have read and agree to the submission timeframe as noted above.

General Information

Submission Date:

Organization Requesting Sponsorship:

To whom should the check be written?

Submitter's Name:

Submitter's Email:

Internal Cost Center/Budget/Gift Fund Number:

Cause/Event/Program:

Event Date:

Event Time:

Location of Event/Program:

Organization's Address:

Contact Person

Title:

Email Address

Phone

Please provide the following information:

Purpose and goals of the Event/Program:

Cause/Event/Program details:

Beneficiary of Cause/Organization:

Community impacts and outcomes-including number estimated to be reached by this 501c3:

Penn State Health mission(s) supported:

Services/Benefits Penn State Health receives as a result of sponsorship:

Demographics impacted:

Penn State Health employees involved (if any):

Penn State Health champion involved(if any):

Please add any accompanying documentation that should be considered with your request including: brochure, packet, flyer, or other informational materials.

If you have questions about this form, please contact Community Relations at 717-531-1698 or CommunityRelations@pennstatehealth.psu.edu.

Contact Information