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Check out the latest UnityPoint Health - Des Moines news

Iowa Methodist Medical Center

Downtown Des Moines | (515) 241-6212

Iowa Lutheran Hospital

East Des Moines | (515) 263-5612

Methodist West Hospital

West Des Moines | (515) 343-1000

Blank Children's Hospital

Downtown Des Moines | (515) 241-5437

John Stoddard Cancer Center

Downtown Des Moines | (515) 241-4141

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Throughout Des Moines

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Contribution Request Form

Organization Contact Name Address City, State, Zip Email Phone Tax ID Title Were you referred by anyone at UnityPoint Health - Des Moines to fill out this form? If yes, please indicate the person's name and their department?Project DetailsName of event/project? Date DescriptionIs this an ongoing project or one-time event? How would you best describe your event?Community/Civic Activity
Education related
Health organization
Non-profit organization
Youth focused OtherDoes this project address either of these health priorities?Healthy weight/Active lifestyle
Access to health care/InsuranceIn which area will this program help to improve the health of the people of Central Iowa?Patient care coordination
Mental health service enhancement
Childhood injury/illness prevention and/or education
General health and fitness
Community improvement/betterment OtherWhat are the benefits to the community if this request is approved?Do you have specific outcome measures? If yes, how will they be measured?Who is your target audience and number of people impacted by the program?How is the event promoted?How many people plan to attend?What are your levels of giving/sponsorship and forms of recognition at each levelIf your request is not awarded this time, do you want it considered for the next period?Yes
No Monetary Donation RequestRequested dollar amountDate contribution neededDoes this contribution help leverage other assistance?Check made payable toHow will the money be used? (percentage to program, expenses, national organization, etc)Does the money raised stay local? If so, what percentage?In-Kind RequestOtherArtwork Request**All promotional material containing our logo(s) will need to be approved by Public Relations before printing.**Logo
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ColorIs there anything else you'd like us to know about your request?Door prize
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