Donation Request Form | UnityPoint Health Grinnell Regional Medical Ce
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Charitable Donation Request Form

If you would like GRMC to consider a request for sponsorship, donation, event participation or contribution, please complete the form below. Applicants will receive an email notification regarding their request within two to four weeks. Questions about requests for funding may be directed to the Office of Public Relations at (641) 236-2946.

Request for (Please Select One):

 Event/Project Name: Date Contribution is Needed (mm/dd/yyyy): Project/Event Purpose of Request: Recognition/Benefit Available to GRMC: Expected Reach of Project: Organization InformationName of Organization:Address: City: State Zip Code: Conatact Name: Affiliation with Group: Daytime Phone Number: E-Mail: Mission/Purpose of Your Organization: