About Us at HSHS St. Francis Hospital

Select appropriate HSHS hospital in Illinois

Date

Name of Organization

Contact person

Contact Number

Email

Organization Mailing Address

Have you spoken with an HSHS colleague about this request?

Yes No

If yes, what is the colleague's name?

What is the primary mission of your organization?

What cities or counties are served by your organization?

Is the organization a 501C3 non-profit agency?

Yes No

Date response needed for request

Must be at least two weeks from request date.

Type of donation requested

Sponsorship amount requested?

Actual event title

Where will event take place?

Please include location and physical address.

Actual event date

Brief description of the request, including how many people are estimated to be served and how the donation will be used

Is this a collaborative effort? If so, please list the major partners and their roles

Will the hospital receive any publicity or recognition for the donation?

Yes No

If yes, please use the link below to upload documentation listing specific publicity and/or recognition by sponsorship level.

Has the hospital provided support in the past?

Yes No

If so, in what way?

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Upload supporting file

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About Us