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Donation & Sponsorship Request

KSB Hospital welcomes the opportunity to help support the needs in our community that fit with our mission “to restore, maintain, and enhance the health of the community,” and to be good community partners in making our area a healthy, safe and enjoyable place to live.

Priority is given to activities that contribute to the three health needs in our community that KSB can best address, which are Diabetes, Obesity and Physical Inactivity, as well as Food Insecurity, as identified in our 2019 Community Health Needs Assessment.

Please fill out the below form with your donation/sponsorship request. Six weeks notice is recommended for all requests.

Date *

Organization Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

501(c)3 Non-Profit? *

Does the organization have employees? *

Briefly describe the organization *

What are you requesting? *

What will the donation be used for? *

Would your event/organization have a need for volunteers? *

What communities/counties will the donation help? *

How many people will the donation help? *

Does the organization have an endowment fund? *

Have you requested donations from us before? *

When do you need the donation? *

If applicable, please share your affiliation to KSB.

Contact Information

Name *

First

Last

Phone *

Email *

Please upload any additional materials here

Click or drag a file to this area to upload.

Questions? Please contact nvarga@ksbhospital.com or call 815-285-8989.

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