Tenet Healthcare Central Valley Area Sponsorship Application

Please select the facility you are requesting a charitable contribution/sponsorship from: ^*

Doctors Hospital of Manteca (Manteca, CA)

Doctors Medical Center (Modesto, CA)

Emanuel Medical Center (Turlock, CA)

All of the Above

Are you a 501(c)(3) organization? ^*

Yes

No (by selecting this, you will be unable to continue application due to not meeting criteria)

Organization Name: ^*

Organization Address: ^*

Contact Name: ^*

Contact Phone: ^*

Email ^*

Provide a brief description of your organization, mission and cause: ^*

Why do you think we would be a good partner for this event? ^*

Event Name 1 ^*

Event Name 2

Event Name 3

Event Name 4

Event Name 5

Date 1 ^*

Date 2

Date 3

Date 4

Date 5

Requested Financial Amount 1 ^*

Requested Financial Amount 2

Requested Financial Amount 3

Requested Financial Amount 4

Requested Financial Amount 5

Please list all sponsorship levels and benefits available for each event (if possible, attach your event(s) flyer): ^*

Use a semicolon to separate each level with benefits included

Have we sponsored your organization’s event(s) in the past? If so, please describe and include sponsorship level: ^*

Is anyone in your organization (board member, staff, volunteer) affiliated with our facility? ^*

Please describe

Please attach your organization’s W-9 (Version 2018 or newer): ^*

Additional Attachments