Special Event Application :: Nationwide Children's Hospital

Special Event Application

Before submitting this application, please review the Special Event Guidelines.

If you have any questions while completing the form, contact us at (614) 355-5400 or by email:
Individuals or Community Groups: Morgen Spon
Corporations and Businesses: Niki Shafer
Schools and Students: Allison Klinefelter

Required Event Information
Part 1: Contact Information
Contact Name
Are you an
Company or Organization Name (if applicable)
Name as you would like to be recognized (Do you want the event name, organization name, individual name, etc.?)
Street Address
Phone Number
Fax Number
Email Address
Web Site
Part 2: Event/Promotion Information
Name of Proposed Event or Promotion
Proposed Date(s)
Event Description
Are there any other beneficiaries of this event or promotion? (Yes/No)
If yes, name of other organization(s)
Location of Proposed Event or Promotion
Projected Attendance
Briefly explain how funds will be raised (ticket sales, pledges, sponsorships, auction, etc.)
Does the event require a license or permit? (Yes/No)
What is your plan for publicity and promotion?
Press Releases
Promotional Flyers
Public Service Announcements
Internet Presence
Please list the anticipated recipients of the above publicity and promotion plan
List businesses, other than your own, that you plan to solicit for donations (cash, service or items)
Part 3: Financial Information
Remember to limit expenses to no more than 50% of gross proceeds. All donations must be made within 30 days of completion of the event or promotion.
Anticipated Total Revenue
Anticipated Total Expenses (Please estimate the individual expenses for the items below)
License/Permit Fee
Anticipated Total Donation
Does your company plan to match the amount you raise? (Yes/No)
How will you transmit your donation to Nationwide Children's Hospital?
I have read, understand, & agree to abide by the preceding guidelines for special events & promotions to benefit Nationwide Children’s. I understand the information I provide is kept on file & will be made available to the public upon request. (Yes/No)
If you click "Submit" and do not receive the confirmation screen, please scroll to the top of the form to see which fields need updated. Your form has been successfully submitted when you receive the confirmation screen. Thank you!
Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000