Become A Partner

Name of Organization/Institution *

Type of OrganizationNonprofitAcademic InstitutionHealthcare ProviderPrivate CompanyGovernment AgencyCommunity GroupOther

Website (if applicable)

Year Established

County & Region of Operations

Primary Contact Name*

Position/Title

Email Address *

Phone Number *

Mailing Address *

Briefly describe your organization's mission and key programs

What kind of partnership are you seeking?Program CollaborationResearch/Innovation SupportEvent Co-hostingResource SharingTechnical/Capacity SupportGrant Co-Funding or SponsorshipOther

Others

What outcomes or impact do you hope to achieve together?

Have you partnered with other foundations before? If yes, please list them briefly

Please outline your proposed idea or project for partnership. Include the issue being
addressed, the approach, and any anticipated outcomes. (Max 500 words)

Please attach (if available)

Organizational Profile or Brochure

Annual Report or Program Summary

Letters of Support or Endorsement (optional)

I confirm that I am authorized to submit this application on behalf of my organization, I also understand that this is an initial inquiry and does not guarantee formal partnership. I agree to be contacted for further discussion and potential due diligence.