Donation Request Form

Please allow 4-6 weeks for processing which includes reviewing, processing paperwork, check procurement and mailing.

 

Date:
Date Donation needed:
Name of Organization:
Contact Person:
Phone:
Email Address:
Address:

 

Are you a Non-Profit Organization with a 501.C.3 status?

Yes      No

 

Have you received funding from Ministry within the past 12 months?

Yes No

 

Have you received funding from other sources for this project?  If so, how much?

 

Type of donation needed Service, Money, Materials, Other. If other, explain (1,000 characters or less)

 

Description of donation needed (1,000 characters or less)

 

Who will benefit from this donation? (1,000 characters or less)

 

How does this request address the three identified health care needs for Door County: Oral Health, Mental Health, Combating Obesity through Healthy Eating/Nutrition/Physical Exercise? (1,000 characters or less)

 

How will Ministry DC Medical Center be recognized? (1,000 characters or less)


 


Please email other forms or supporting material to
Sandy Sievert: sandy.sievert@ministryhealth.org or
Kevin Grohskopf: Kevin.grohskopf@ministryhealth.org

Exclusions include:

  • Capital campaigns and endowments
  • Individual and personal initiatives, including individual employee/family initiatives (other than possible in-kind support)
  • Political organizations
  • Programs which may be in conflict with Catholic Health Care values