Community Vitality Funding

For questions regarding this form, please contact Julie Jank at Julie.Jank@allegiancehealth.org or (517) 841-7455.

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.

Files must be less than 5 MB.
Allowed file types: gif jpg png txt pdf doc docx ppt pptx xls xlsx zip.


Information in the form of flyers and sponsorship levels is appreciated. If there is only one file, you can attach it here. Otherwise, you'll need to email it to Julie Jank.

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