Sponsorship Donation Request Form
Washington County Hospital and Clinics (WCHC) recognizes it must balance its role as a good steward of its financial resources and its role as an important partner to the community it serves. To help guide in that effort, this policy offers criteria and procedures to aid in responding to the many requests for charitable donations, event sponsorships, and in-kind requests received by Marketing and WCHC administration and staff.
WCHC's mission is to be the central resource for improving health and promoting wellness to all our communities. As such, we endeavor to support the efforts of community organizations that relate to the mission, values, vision, and community benefit objectives of the hospital. As a non-profit community hospital, WCHC gives careful consideration to requests for financial and in-kind support as they relate to our objectives for community health and wellness.
Those requests that measurably improve the community health and quality of life will be given the highest priority for consideration for potential support. Funds are limited, and we regret that we cannot approve all requests.
To be considered, a request for sponsorship or funding must meet all of the following criteria:
• The event or project must directly benefit the geographic area served by WCHC.
• The event or project must relate to one or more of the following priorities: Health, Fitness, Safety, and Wellness. Community Development.
• The requesting organization must be perceived to be effective and the activity must be relevant to the
perceived needs of the community.
• The requesting organization must have a current 501(c)3 non-profit, tax exempt status under IRS code
Section 170, or be a governmental agency or department, or a public educational institution.
• The requesting organization must demonstrate effective program performance in addition to financial
responsibility and accountability.
• The request must meet the promotional needs of WCHC with recognition of sponsorship acknowledged through
the approved use of our logo in advertising, public announcements, and other materials produced for the
event or project. Use of WCHC logo must be approved by the WCHC Marketing Department in advance.
WCHC reserves the right to deny any request, at its sole discretion. Funding in prior years does not guarantee continued funding in any subsequent year.
WCHC is a non-profit community hospital. As such, our funds are limited and will generally be made to organizations that have the greatest opportunity for positively affecting the health and wellness of the community we serve. It is our policy not to approve funding for the following:
• Requests from organizations that are engaged in political or governmental activities.
• Requests from religious organizations or for religious activities.
• Requests from commercial, for-profit businesses
• Requests from or requests that benefit single individuals
• Requests and/or events that do not improve the health of the greater Washington community
• Individual scholarships
Procedure for Sponsorship/Donation Request
Requests for sponsorships, donations, or in-kind support that are not part of the operational Marketing plan must be submitted in writing using the Community Sponsorship/Donation Request Form. Submit your sponsorship/donation request no later than 10 weeks prior to the start of your event.
• Sponsorship requests will be reviewed on a monthly basis.
• Include any supporting documentation with your request form at the time of submission.
• Incomplete Request Forms will not be considered.
• WCHC may request a post-event performance report detailing how the contribution was used, how many people were impacted, and how WCHC was recognized.
Please return completed Sponsorship/Donation Request Form to:
Washington County Hospital and Clinics
PO Box 909
Washington, IA 52353
Questions about sponsorship/donation guidelines and process may be directed to firstname.lastname@example.org.