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Home : About Meriter : Community Giving : Apply for a Gift

Community Giving

Apply for a Gift Form

Interested in Applying for a Gift?

If you are involved with a non-profit organization that improves the health and well-being of our community, Friends of Meriter encourages you to apply for a Friends 4 Friends gift. Please fill out the questions on this page. Note that Friends of Meriter has the right to approve or disapprove all funding requests.

If you would like to send any supporting materials, please send them to: Volunteer Services/Friends of Meriter, Meriter Hospital, 202 S. Park Street, Madison, WI 53715. Please note which gift request they relate to.

Submission Form

* = Required Fields

About You
* Name:


* Address:


* City:


* State:


* Zip Code:


* Email Address:


  About the Organization
Organization to Receive Gift:


Address:


City:


State:


Zip Code:


Contact Person of non-profit organization:


Contact Person's Phone Number:


IRS Non-profit Organization:
Yes
No
  Relationship to Meriter
(Note that you must have a relationship to Meriter to request a gift)

Employee
Meriter Department and Ext.:

Volunteer
Physician
Friend of Meriter