Sponsorship Request - Southern New Hampshire Health

Southern New Hampshire Health (SNHH) is committed to supporting projects and events that relate to our mission, vision and values, and address the following community health priorities:

Behavioral Health for Children and Adults
Weight Management, Nutrition and Physical Fitness
Access to Healthcare including Dental Care
Healthy Moms and Babies
Chronic Disease and Cancer Prevention
Communicable Disease Prevention

Non-profit community organizations are invited to request sponsorship support for programs, runs/walks, health fairs, and the like. Please complete the Request for Sponsorship Form below and allow thirty (30) days for your sponsorship request to be considered.

Full Name:
Professional Title:
Organization Name:
Email:
Phone Number:
Event Name:
Event Date:	Today
Event Location:
Event Website:
Event/Program Purpose:
How will this event be promoted?:
Which Immediate Care center serves the majority of your participants?:
Which of our Community Health priorities best fit your program/event? (please check all that apply):	Behavioral Health for Children and Adults Weight Management, Nutrition and Physical Fitness Access to Healthcare including Dental Care Healthy Moms and Babies Chronic Disease and Cancer Prevention Communicable Disease Prevention
How many people do you anticipate participating in your program/event?:
Attach Event Flyer/Sponsor Info:
When was the last time Southern NH Health sponsored your organization?:
Purpose of previous sponsorship:
Please identify the anticipated number of people benefitting from your program/event
Children 0-5:
Youth 6-17:
Adults 35-64:
Seniors 65+:
Total: