Thank you for contacting Memorial. Please use the form below to make your request.
Memorial Health System (MHS) receives numerous requests from
community organizations for donations, sponsorships or participation in
special events. As a nonprofit organization, MHS must give careful
consideration to whether and to what extent these requests support our
mission to improve the health of the people and communities we serve.
We also strive to address our identified community priorities of
cardiovascular disease, diabetes, obesity and increasing access to
health care services. Preference will be given to supporting community
programs that are improving the health status and quality of life for
underserved, low-income or vulnerable members of our communities.
Nonprofit 501(c)(3) organizations, tax-exempt entities and other
organizations may submit a request for support a minimum of six weeks in
advance. Completion of this application does not guarantee funding of
your request. Please be prepared to submit your organization’s IRS W-9
form where requested in the request form below. If you do not have a W-9
form, you can find information on the
If you have a question about the form, please contact email@example.com or call 217-788-7014.
* denotes required fields.
We will contact you within two weeks of receiving your request. A
confirmation email will be sent to the email address supplied.