Community Grant Program Please review our Donation Guidelines before submitting your request.View as a PDF: Community Grant Donation Guidelines and ApplicationName of Organization:*Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person:*Phone:*Email:* Preferred Method of Contact:*PhoneEmailOrganization Web Address: What area does your organization serve?*How does your organization serve our community?*RequestPlease describe your request:*How does this donation or item benefit the community if approved?*Has ECM Hospital donated to your organization in the past?*YesNoType of Request:(check all that apply) Monetary ItemAcknowledgementHow will ECM Hospital be acknowledged for the donation?Do you need a logo or advertisement?*YesNoPlease attach price list, entry form, flyer, or last year's ad if available:I've read and understand the Donation Guidelines:Donation Guidelines Yes This iframe contains the logic required to handle Ajax powered Gravity Forms.