Charitable Giving Form

ER - Madison

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UnityPoint Health - Meriter Community Relations is pleased to partner with over 70 community organizations each year. We take great pride in being the community hospital and working collaboratively with our community to address the health needs of our residents.

Our charitable giving is aligned with the Healthy Dane Collaborative 2016-2018 Community Health Needs Assessment (CHNA) identified health priorities. The CHNA is also available to review.

These priorities include:

  • Mental health
  • Maternal and child health
  • Active living and healthy eating
  • Falls prevention

We invite funding proposals that demonstrate innovative and evidence based programs to reduce disease burden as well as those having a strong evaluation and sustainability plan.

We do not fund:

  • Political entities/lobbying
  • For profit organizations
  • Capital campaigns
  • Events such as fun runs, golf outings, fundraisers

If you believe you have a strong funding proposal, we invite you to fill out the form below.

OrganizationLast NameFirst Name  Address Zip CodeCityState   Phone NumberE-Mail  Geographic Area ServedOrganization Website Is Your Organization a 501(c)3?What percentage of your dollars stay local?Please rank your organization goals:Program/Event NameStart and End DateType of Donation Please specify amount or describe the participation needed:Program/Event Description (include anticipated health impact/outcome)How many years have you hosted this program/event?Anticipated number of participants/attendees:How will you promote this program/event?How will this program/event contribute to the health and wellness of participants and/or community?What is your preferred response deadline?