Afiyavest Community Health Initiative (AfiCHI) | Community Care Sponsorship Form

Afiyavest Community Health Initiative (AfiCHI) – Sponsorship Expression of Interest

Thank you for your interest in sponsoring community care in underserved communities in Nigeria. This form helps us understand your objectives, preferred focus areas, locations, timelines, and reporting needs to enable effective collaboration and execution.

Section 1: Organization / Individual Profile

Name of Organization / Individual *

Organization Type *

Industry / Sector (if applicable)

Brief Description of Organization or Sponsorship Interest *

Section 2: Contact Information

Primary Contact Person – Full Name *

Designation / Role

Email Address *

Phone Number (WhatsApp preferred) *

Office Address (if applicable)

Preferred Mode of Communication *

Section 3: Sponsorship Focus Areas

AfiCHI focus areas you are interested in supporting *

Community Medical Outreach (free consultations, basic treatment, maternal and child health, essential medicines) Preventive Healthcare Education (malaria prevention, hygiene, nutrition, maternal and child health, NCD awareness) Routine Immunization (RI) Sensitization and Community Engagement Group Health Insurance Enrollment for Vulnerable Households Integrated Community Health Interventions (combined approach)

Select at least one.

Primary Motivation for Sponsorship *

Section 4: Geographic Focus

Preferred State(s) for Intervention *

Preferred LGA(s) or Communities (optional)

Section 5: Sponsorship Scope and Target Goals

Estimated Number of Beneficiaries *

Indicative Sponsorship Budget Range (optional)

Type of Support You Are Willing to Provide *

Financial Sponsorship Medical Supplies / Drugs Logistics Support Health Insurance Premium Sponsorship Media / Advocacy Support Combination of the above

Select at least one.

Section 6: Timeline and Implementation Preferences

Proposed Timeline for Sponsorship Engagement *

Preferred Implementation Period (optional)

Preferred Start Date (optional)

Section 7: Reporting, Visibility, and Engagement

Reporting Expectations *

Beneficiary and impact report Financial accountability report Photo and video documentation Monitoring and evaluation dashboard

Select at least one.

Brand Visibility and Recognition (optional)

Logo placement on outreach materials Media mentions and press releases Social media visibility Community engagement and recognition Not required

Section 8: Additional Information

Specific Requirements, Conditions, or Expectations (optional)

Have you previously supported community health or similar initiatives? *

If yes, please briefly describe (optional)

Section 9: Consent

I confirm that the information provided is accurate and I am interested in exploring a sponsorship partnership with Afiyavest Community Health Initiative.

Submission Note: Upon receipt, the Afiyavest Community Health Initiative team will review your submission and contact you within five working days.