Community Based Organization Sponsorship & Funding Request

The mission of the Alameda County Public Health Department is to work in partnership with the community to ensure the optimal health and well being of all people through a dynamic and responsive process respecting the diversity of the community and challenging us to provide for present and future generations.

Alameda County Public Health will consider event sponsorship & funding requests from qualified non-profit organizations (or unincorporated public benefit organizations with qualified fiscal sponsors) that serve County residents.

Qualifying events must be directed to Alameda County residents and be consistent with the mission of the Department.
Any funds awarded must be spent by the end of the same year as the award.
Requests for sponsorship and funding must be submitted a minimum of 60 days prior to the event.
Request to sponsor and fund political organizations, charitable foundations, private commercial concerns, religious events, and individuals are ineligible and will not be considered.

In order to be considered for County sponsporship of your event and funding request, you must complete and submit this form.

CBO Event Sponsorship Request Form

* Required

Prepared By

* First Name:
* Last Name:

* Title:
* Organization:

* Email:
* Phone Number:
Example: 555-555-5555

* Website:

Application History and Current Status

* Briefly describe your organization’s history and current legal status.

Be specific whether your organizations is currently a 501(C)3 or other type of non-profit organization.

Event Description

* Describe the event for which your organization seeks County sponsorship and funding.

Include date(s), time, purpose, geographic location, and anticipated number of attendees and related demographic information such as race, ethnicity, age, income, and other relevant information.

Debarment

A Person who is placed on the Debarment List is a Debarred Contractor and prohibited from submitting bids, submitting responses to request for proposal or qualifications, receiving Contract awards, executing Contracts and participating as a Subcontractor, agent or representative of another Person contracting with the County.

* Has your organization been debarred from County contracts?

Fiscal Sponsor

A fiscal sponsor is "a nonprofit organization that provides fiduciary oversight, financial management, and other administrative services to help build the capacity of charitable projects".

If your business is not a qualified 501(c)(3), you are required to have a fiscal sponsor and must fill out this section.
If your business is a qualified 501(c)(3), filling out this section is optional.

Please specify whether your organization will rely upon a fiscal sponsor to qualify for the CBO Event Sponsorship funds.

* Are you a qualified 501(c)(3)?

This section must be filled out if you are not a 501(c)(3) :

Organization:

Address:

Website:

Principal or Exec. Dir.:

Email:

Phone Number:
Example: 555-555-5555

Attach PDF of a letter from your fiscal sponsor confirming their agency:

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