Prairie Lakes Healthcare System

Fields marked with * are required

To be considered for a Prairie Lakes sponsorship, please completely fill out the form below.

Date

Address

City, State, Zip

Contact Name

Organization

Phone

Website

Tax-exempt status

501(c)3 organization government agency public education institute

Purpose/Mission of your organization

Donation Requested (be specific)

Date needed

Name of project or event

Description of project or event

How does this project or event benefit the community?

How will you measure your success?

How will Prairie Lakes be recognized/benefit?

Names of donors who have made commitments to this project/event

Additional information

Community Benefit Donation Form