Twitter Organization Name * Organization Street Address * Organization City * Organization State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Organization Zip Code * Organization Phone * Organization Email Address * Submitter's Title * Submitter's First Name * Submitter's Last Name Submitter's Email * Requesting Organization's Mission Please provide a summary of the organization's mission Donation Information Specific dollar amount requested If you are requesting a silent auction basket, please check the box below Silent Auction Basket If you are requesting a specific item for donation, please indicated below (Examples: First Aid Kit, CPR Training Kit) Donation's Impact Please provide a description of the organization's program/service the donation will be used for. Please provide a description of how will the donation be used to further develop the organization. Please provide a description of how outcomes/results will be measured. Please provide information on where the donation will be used? For example: a Charity Auction to support ABC Non-Profit in Manitowoc, WI. Please provide the date of your event or when the donation will be used. Requesting Organization's Funding Please provide information about other sources of the organization's funding. Please provide details about the organization's unrestricted net revenue. Please provide information about other organizations that the requesting organization collaborates with. Please review our mission and values. Our Mission Holy Family Memorial is a network of health professionals who, rooted in the healing ministry of Jesus Christ, provide services to help individuals and our communities achieve healthier lives. Our Values Holy Family Memorial, as a network and in partnership with others, will be the clear choice for healthcare in the lakeshore region, recognized as the leader in patient-centered, excellent medical care, while delivering valued outcomes in a Christian environment. Please explain how your organization and requested donation will be used to meet our values and mission.