Sponsor Intake Form

For any questions, please contact:

Victor Ukwu, MD
victor@mavencommunityhealth.org
(215) 740-2732

Organization Information

Sponsor/Organization Name

Primary Contact - Full name

Primary Contact - Title

Phone Number

Mailing Address

Industry Sector

Size

Large Small Minority-owned

CSR Priorities

Sponsorship Interest

Preferred Tier

$50k Legacy Presenting Sponsor: Own the Love • Labor • Legacy story for 2026 $25k Labor Champion Sponsor: Power the work on the ground $10k Love Circle Sponsor: Help bring men and fathers & sons into the room $5k Brotherhood Champion: Branded session + on-site booth $2.5k Community Ally: Vendor booth + digital spotlight $1k Community Pair Sponsor: website/ad-journal thanks $500 Micro-Sponsor

Specific Program(s) of Interest (check all that apply)

Health Combine Barbershop Talks Legacy Lab Mentor Breakfast Other:

Mission Alignment Statement

Engagement Preferences

Visibility Opportunities Desired

Logo placement Exhibitor table Social media In-kind donation Panel/Break out participation

Storytelling Interest

Yes – open to content capture/spotlight No – prefer anonymous giving

Employee Engagement Options

Volunteer opportunities Tickets for staff Mentorship roles

Reporting & Metrics

Metrics of Most Interest

Community Reach (# of attendees, screenings, father–son pairs) Health Impact (screening uptake, referrals) Workforce/Productivity ROI Equity/DEI outcomes

Preferred Reporting Format

Dashboard summary Narrative report Case study/storytelling

Next Steps

Timeline for Decision

<30 days 30–60 days >60 days

Fiscal Year Cycle

Authorized Signatory - Full name

Authorized Signatory - Title

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