Request Form

If you wish to submit a community sponsorship request, please complete and submit the on-line request form below. If you have any questions about the form or process, please send us an e-mail communitysponsorships@atlanticare.org

COMMUNITY SPONSORSHIP REQUEST FORM

Upon receipt of this completed form, your request will be reviewed. Only requests from 501(c)(3) organizations whose mission aligns with AtlantiCare’s vision and mission will be considered.

NOTE: Items with an asterisk (*) must be completed prior to submitting!

Full Name (*)

Please type your full name.

Phone:

Invalid Input

E-mail (*)

Invalid email address.

Your Organization

Organization Name (*)

Invalid Input

Address: (*)

Invalid Input

Address 2:

Invalid Input

City: (*)

Invalid Input

State:

Invalid Input

Zip Code (*)

Invalid Input

Mission & Vision of Your Organization (*)

Invalid Input

Number of AtlantiCare Employees Served by Organization Annually (*)

Invalid Input

Number of Persons Served by Your Organization Annually (*)

Invalid Input

Is Your Organization Funded by the United Way? (*)

YesNo

Invalid Input

About Your Request

Description of Community Sponsorship Request (please include information about event including event honoree) (*)

Invalid Input

What area of concentration does your organization fall under? (*)

CommunityHealth/Human ServicesArt/Culture/Education

Invalid Input

Type of Request (*)

Invalid Input

Name, Date and Location of Event (*)

Invalid Input

Ad Specs
(Format submitted by AtlantiCare will be high resolution pdf.

Invalid Input

Attach Document
(Must be less then 5mb and Word, Excel or PDF file)

Invalid Input

If approved, where should sponsorship check be sent? (*)

Invalid Input

To help us avoid computerized spam, please type in: (*)

Invalid Input

Submit