The six affiliates of Memorial Health System work together to fulfill our mission to improve the health of the people and communities we serve.
Home  >  About MHS  >  Community Support Request

Community Support Request


Community Support Request

Thank you for contacting Memorial. Please use the form below to make your request.

Memorial Health System (MHS) receives numerous requests from community organizations for donations, sponsorships or participation in special events. As a nonprofit organization, MHS must give careful consideration to whether and to what extent these requests support our mission to improve the health of the people and communities we serve.

We also strive to address our identified community priorities of cardiovascular disease, diabetes, obesity and increasing access to health care services. Preference will be given to supporting community programs that are improving the health status and quality of life for underserved, low-income or vulnerable members of our communities.

Nonprofit 501(c)(3) organizations, tax-exempt entities and other organizations may submit a request for support a minimum of six weeks in advance. Completion of this application does not guarantee funding of your request. Please be prepared to submit your organization’s IRS W-9 form where requested in the request form below. If you do not have a W-9 form, you can find information on the IRS website.

If you have a question about the form, please contact or call (217) 788-7014.

Bold text denotes required fields.


Contact Information

Organization Information

Request Information

Community Support Information

Memorial Health System Information