Mini-Grant Application Form - Owensboro Medical Health System

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Mini-Grant Application Form

Mini Grant Application Form

* Denotes required field

* Event Name

* Date of Request

(mm/dd/yyyy)

* Amount of Contribution Requested

(Enter whole dollar amount.)

Requestors Information

* First Name

* Last Name

* Organization/Department

* Address

* City

* State

* ZIP Code

* Phone

(xxx-xxx-xxxx)

* Email

Event Details

* (date, location, day of event involvement, giveaways to be provided at event, recognition of OMHS at event, other marketing needs, etc)

Project Description:

* Briefly describe sponsorship, how the funds will be used and how it supports the OMHS mission.

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Mini Grant Application Form

Requestors Information

Event Details

Project Description:

270-688-2000
For information about OMHS

1-877-888-OMHS
For answers to your health questions, 24 hours a day

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Mini Grant Application Form

Requestors Information

Event Details

Project Description:

270-688-2000 For information about OMHS

1-877-888-OMHS For answers to your health questions, 24 hours a day

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270-688-2000
For information about OMHS

1-877-888-OMHS
For answers to your health questions, 24 hours a day