Sponsorship Form

Contact Information

Name of Person Submitting *

Name of Person Submitting

First Name

Last Name

Agency / Institution

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Email *

Contact Phone

(###)

###

####

Event Requesting Sponsorhsip Funding

Event Description

List Event Partners (If Any)

Additional Information

Have You Hosted Before?

In the past year, have you hosted an evidence based sexual health program at your agency or institution?

Yes

If yes, please provide name of agency and curriculum

Have You Used Our Referral System Before?

In the last year, have you used the Referral System housed at ConnectSpartanburg.org?

Yes

If yes, how many referrals?

Requested Sponsorship Amount

Additional Information or Comments

Have Questions?