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2025 Sponsorship Application

As an active member of the community, Haywood Regional Medical Center (HRMC) supports many organizations through monetary and in-kind donations annually. It is the policy of this hospital to contribute to activities, organizations and causes in our community that align with our mission of Making Communities Healthier. Please visit MyHaywoodRegional.com/sponsorships for funding guidance and deadlines before submission.

Name of Organization

Event/Request Title

Contact Person

Street Address

City

State

Zip Code

Phone

Email

Is the organization a nonprofit or educational institution?YesNo

Tax ID# (if nonprofit)

Type of Sponsorship RequestedMonetaryIn-Kind

Amount Requested:

Have you received a monetary or in-kind donation from this hospital in the past?YesNo

If you have received a donation from the hospital in the past, please share how much and when.

List any other major contributors to this event/cause:

Are any other fundraisers planned (or have taken place) this fiscal year? Please list.

What percentage of the money you raise goes toward administrative costs?

Please classify your program below (select one):

How many people will benefit directly from your efforts/this event?

If this request is for a specific event, list the date(s) of the event:

Does your organization serve people in Haywood County/is the event in Haywood County?YesNo

Are any hospital employees or board members actively involved in your organization?YesNo

If you answered yes to the question above, please list their names and functions within your organization.

What is your organization's mission?

How will the funds you are apply for be used? Please be as specific as possible.

How will this project address local community needs?

How will you measure the success of your project?

I certify that the information above is correct and that the sponsorship, if approved, would be used solely as described above.YesNo

262 Leroy George Drive
Clyde, NC 28721

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