Community Health Impact Connection

Florida Hospital

Our Healthy Futures

Our Healthy Futures

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Form Instructions

Click on and complete the form (at right) that corresponds with the amount and/or purpose of your request. Then click SUBMIT at the bottom of the form, and it will be sent to CHiC.

Contact Details

ADDRESS
Community Benefits
2710 N. Orange Ave.
Orlando, FL 32804

TEL 407-303-9582
FAX 407-303-7225

EMAIL info@mychiconline.org

Forms

Impact Sponsorship Request

Submission Form for $5,001 - $25,000

Contribution Request

Submission Form for $5,000 or less

Free Trial User Agreement

Acknowledgment & Profile Form

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