Test form

Is your organization a 501(c)(3) nonprofit entity?yes
no

Are you able to submit documentation supporting your current status as a nonprofit? yes
no

Is your organization affiliated with any of Coloplast customers from any business areas?yes
no

Email:

Organization name and address:

Phone number:

Please provide the names, titles, and company of all individuals serving on the Board of Directors of your organization:

Name:

Organization:

Please provide the names and titles of all members of the leadership team/executive management of your organization:

Name:

We will award a maximum amount of $10k per grant. Please enter the amount of funding requested by your organization:

Is your organization based out of Minneapolis?yes
no

Organization mission statement:

Through our Community Grant program, Coloplast awards grants to organizations that focus on developing the next generation of healthcare professionals in underserved and underrepresented communities located across the Twin Cities. We will prioritize organizations that offer medical-specific or STEM-related programming to youth and/or adults. Please provide a description of your organization and relevant programming along with how a Coloplast Community Grant would be used. Please include information about the people and/or communities you serve:

Wyrażam zgodę na przetwarzanie moich danych osobowych przez Coloplast Sp. z o.o. ul. Inflancka 4, 00-189 Warszawa w celu wysłania próbki produktu wraz z informacją towarzyszącą zgodnie z Informacją o ochronie danych osobowych.Informacja o ochronie danych osobowych.

Does your organization offer any volunteer opportunities? If so, what are they?

contactUsBysendUsEmail

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