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Community Donation Request Application

Mid-Columbia Medical Center has a long history of providing financial support to local organizations and projects that share our goal of improving the quality of life and health of the communities we serve. Most contributions to this end are made from the Community Tithing Fund, through which donations are made to organizations based on the hours MCMC employees volunteer to their cause. In addition, in appropriate circumstances and as hospital finances allow, contributions are made to qualifying community organizations and projects outside of our tithing program. In general, these donations are made to not-for-profit organizations (not individuals) in support of activities with broad community appeal or that are aligned with the mission of Mid-Columbia Medical Center.

If you would like to make a request for support, please complete and submit the application below. We will respond to your request within 10 days, after it has been reviewed by MCMC Administration.

Contact Information	= Required Fields
Name of Organization
Is your organization non-profit?	YesNo
Mailing Address:
Mailing Address2:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Federal Tax ID#:
Authorized Contact:
Phone:
Email:
Alternate Contact:
Donation Request Information
Please describe the organization, project or event for which you are seeking a donation. (for events, please include date, location and anticipated attendance)
Amount of donation you are seeking:	$
Are you seeking a General Donation or requesting that MCMC serve as a Financial Sponsor of an event?
General DonationFinancial Sponsorship
Please describe what the sponsorship entails and include different levels of sponsorship, if available: Please describe how this General Donation contribution from MCMC would be used:
NOTE: If your request is approved, you will be asked to complete and provide to MCMC a W-9 form if we do not already have one on file for your organization.
Please type the letters you see above.
Submit Application