Glidewell Corporate Giving

Are you U.S.-based?*

YesNo
Note: Organizations may serve internationally, but requestors must be U.S.-based. Supplies can only be shipped within the U.S.
Is your request aligned with one of the four focus areas of giving?*

YesNo
I'm sorry, answering "Yes" is required to complete the application.
I'm sorry, answering "Yes" is required to complete the application. To learn about our Four Focus Areas of Giving, click here.

Which description best represents you or your organization?*
Attach proof of accreditation for the university or CE program*

Accepted File Types: pdf, doc, docx
Cancelof
Are you applying as a 501(c)(3) nonprofit organization?*

YesNo
501(c)(3) IRS ID Number*
Healthcare Provider's Full Name*
License Number*
Full Name*
Organization*
Name of the Clinic
I’m sorry. If you are not applying as a federally designated nonprofit, please go back and select a different focus area of giving.
Please explain in detail*

Contact Information
Specify Your Role Related To This Request
(ex. Receptionist, Director, Grant Writer, Dentist, etc.)
Name*

First NameLast Name
Do you have a Glidewell account?*

YesNo
What is your account number?*
Phone Number*
Format: (000) 000-0000.
Email*
Name of Organization (if applicable)
Shipping Address (if applicable)

Street Address (No P.O. Boxes)

Street Address Line 2

CityState

Zip Code

Project Information
What type of donation are you requesting?*

Restorative solutions and/or prosthesesEquipment for a university/education programSponsorship for a speaking engagementSponsorship for a medical missionMonetary donation to nonprofit organizationIn-kind donation to nonprofit organizationOther
Project Title*
Project Overview*

0/0
Estimated Cost*
Note: Please estimate the monetary value of your giving request.
Describe your goals for this donation request*

0/0
Please indicate the date you hope to receive the donation*

MonthDayYear
Note: We review applications on a quarterly basis.
Link any relevant websites where we can learn more about you or your organization
Were you referred by a Glidewell team member? If so, please list their name

If we are able to support your program, we require that you share the impact of your efforts. Following the completion of your project, we ask that you share the following via an impact statement: Number of people served, dollar value of the event/program (estimated), summary of the project.
Do you agree to submit this report within 90 days of completion date, as outlined above?*

YesNo
I'm sorry, answering "Yes" is required to complete this form.
Signature*

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Contact Information