Sponsorship - Chartrand Orthodontics

Form for the Request of Sponsorship or Donation

Thank you for your interest in Chartrand Orthodontics philanthropy program!

Dr. Chartrand values the many academic, public, and private programs and associations that strengthen our local communities.

We would love nothing better than to be able to contribute to all who ask, but the high volume of requests may prohibit us from doing so. To make the application process as fair as possible, the following criterion is used to review your request:

Requests must be made by an active patient in the office (meaning in braces) and must be made by the person participating in the fundraiser.
Requests must be made via our request form (separate documentation may be attached.)
Requests are due by the 15th of the month and will be reviewed once a month. Notification will be made by the end of each month.

Thank you for giving us a chance to learn about, and participate in, your program!

Contact Person(Required)

Email(Required)

Phone(Required)

Organization Name(Required)

Event Date(Required)

Date by Which Donation is Needed(Required)

Event Description(Required)

Describe your philanthropy, event, organization, and general reason for requesting donation.

Dollar Amount(Required)

Payable to Whom(Required)

First Last

Address to Mail Check(Required)

Street Address Address Line 2 City State ZIP Code

Attachments(Required)

Max. file size: 50 MB.