Community Vitality Funding

For questions regarding this form, please contact Julie Jank at Julie.Jank@allegiancehealth.org or (517) 205-7455.

Personal Information

Details of Request


Please indicate the type of support you are requesting:

$


Please indicate whether any of the following opportunities are provided to sponsors:



Please indicate the primary audience(s) served (check all that apply):




Please indicate your desired deadline for a confirmed sponsorship or donation.


Information in the form of flyers and sponsorship levels is appreciated. After submitting the form, please email them to Julie Jank.

Unexplained shortness of breath, panting or the inability to take a deep breath may be warning signs of a heart attack, with or without chest pain. Call 911 if you experience these symptoms.