Community Benefit and Sponsorship Application

Organization Information



 

 



 

Point of Contact


 


 

Past Partnership

Has your organization received funding from Northern Light Health or any of our affiliates in the past? Such as Northern Light Home Care & Hospice, Northern Light AR Gould Hospital, Northern Light Mercy Hospital, Northern Light Eastern Maine Medical Center, etc.
 

 

 

 
If yes, we are generally unable to accept multiple funding requests during the same fiscal year. Please reach out to mrarcher@northernlight.org with any questions.

Sponsorship Level



 

Tier one: (up to $999)

  • Submission of an itemized budget outlining how the funding will be used

Tier two: ($1,000-$4,999)

  • Submission of an itemized budget outlining how the funding will be used
  • Within 30 days of completion of the project/event, the submission of a brief report is required
  • If applicable, co-branding or public recognition of the sponsorship will be required

Tier Three: ($5,000-$10,000)

  • Significant initiatives which address Northern Light Health Community Health Improvement Priorities:
    • ​Substance Use: Improve pathways to prevention, treatment, and recovery
    • Social Determinants of Health: Increase access to transportation, safe and affordable housing, food security
    • Mental Health: Ensure children and families have the mental and behavioral health resources they need to thrive
    • Equity & Inclusion: Initiatives that advance health equity, social justice, and inclusive access to healthcare or community services for vulnerable people
    • Climate Resilience: Initiatives which mitigate the impacts of climate change and foster environmental sustainability
  • Submission of an itemized budget outlining how the funding will be used
  • Within 30 days of completion of the project/event, the submission of the impact report will be required. This will include a photo of the event demonstrating how it has positively impacted the community.
  • Co-branding and/or recognition of Northern Light Health sponsorship will be required 

Project Details


 
What is the date, time, and location of your event/project? Please keep in mind that per the application process requirements, projects funded by Northern Light Health are to be completed and reported on before the end of the fiscal year in which they were approved (October 1-September 30).
limit 3000 characters (about 350 words)
 

limit 3000 characters (about 350 words)

Sponsorship Budget

 
Revenue Amount
Grant from Northern Light Health:
Event Registration:
Other Funding Sources:
Total Revenue:
   
Event Expenses Amount
Marketing and Social Media:
Insurance:
Services and Support:
Catering / Food:
General Supplies: 
Other Expenses:
Total Expenses: 

 

What is the target population? Be specific. Examples would be “people with diabetes”, or “women without insurance.
limit 3000 characters (about 350 words)
 

 
What geographic area in Maine does your project target?:


 
Please select which objective most aligns with your project purpose:
 

limit 3000 characters (about 350 words)
 

limit 3000 characters (about 350 words)
 

limit 3000 characters (about 350 words)
 
If applicable, what recognition or acknowledgement will Northern Light Health receive? Examples would be our name/logo displayed on handouts, program brochures and/or banners, verbal recognition when addressing those who attend, etc.
limit 3000 characters (about 350 words)


** If your file upload exceeds 20 MB, please email your files directly to Melony Archer at mrarcher@northernlight.org **





 

If you have questions about the application process, please contact Melony Archer at mrarcher@northernlight.org or call us at 207-973-6564