Sponsorship & Donation Request Form

Lexington Regional Health Center values supporting initiatives that promote health, wellness, and community development. Completing this form helps us review requests fairly and ensure they align with our mission and available resources.

Please submit requests at least 30 days prior to the event or when the donation is needed.
Do not include any personal health information (PHI) in your submission.
LRHC primarily supports nonprofit or community organizations that benefit the local area and focus on health, wellness, education, youth, or community improvement.
Requests for individual fundraisers, personal benefit events, political campaigns, or religious organizations are not eligible.

Contact Information

Contact Name

Organization Name

Email

Phone

Address

Address 2

City/Town

State

ZIP/Postal Code

Requested Support

What are you requesting?

Requested amount or description of support:

Date of Event or Sponsorship Due Date

What recognition will LRHC Receive?

What recognition will LRHC receive?

Attach Additional Information

One file only.
5 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Additional Photos

Maximum 4 files.
8 MB limit.
Allowed types: gif, jpg, jpeg, png.