Complete connected care℠ A Circle Health Member

Community Support Sponsorship Form

Thank you for your interest in seeking support from Lowell General Hospital/Circle Health. As the second largest community hospital in the state, Lowell General Hospital's commitment to our community is an essential and integral part of our mission, vision and strategy. We seek to improve the health status of the community we serve, and to specifically address the health problems of at-risk and medically under-served populations.

Please review our funding guidelines before submitting an application. All requests must be submitted using the online application below.

Please note: Due to the COVID-19 crisis, funding resources are extremely limited. We thank you in advance for your patience and understanding as we continue to respond to this pandemic and serve our community.

For questions, please contact sponsorship.request@lowellgeneral.org.

All fields are required unless otherwise noted.

Contact Information

General Information

Organization Information

Federal Employee Identification Number

Contact Information

A receipt will be sent to this email address.
Event/Program Request Information

General Information

Requests must be made at least 6 weeks prior to event/program date.
Questionnaire

Questionnaire

Attachments

Attachments

File must be either PDF, MSWord, or TXT.
Leave this field empty

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