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Test Frank2

Organization Information
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Please provide director's first and last name.
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Please enter in nnn@xxx.ddd format
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Please enter in 999-999-9999 format
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Please enter in 999-999-9999 format
Please enter in www.domain.xxx format
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Point of Contact
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Please enter in nnn@xxx.ddd format
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Please enter in 999-999-9999 format
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Activity Information
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Enter in MM/DD/YYYY format
Enter in MM/DD/YYYY format
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Please enter in www.domain.xxx format
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Brief description of how the activity aligns with Baystate Health's community benefits mission.
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Who is the target population for your activity? (check all that apply)






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Fiscal Information
What is the total budget for the activity?


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What is the amount requested from Baystate Health?


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Has your organization requested funding from Baystate Health in the past?
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Will proceeds of this activity (if any) directly benefit residents of western MA?
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Were you referred by a Baystate employee, board member or volunteer?
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Captcha

 
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After submitting this form, you will receive an automated email response from the Office of Public Health and Community Relations. We invite you to submit additional sponsorship proposal documents by replying and attaching documents to our automated reply. Due to the volume of requests we receive, please be mindful of file sizes.