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Foundation Donation Request



HealthEast Foundation Donation Form
  1. Thank you for making a contribution through HealthEast Foundation. Your gift will benefit patients and support the high quality and compassionate health care services and programs of HealthEast Care System.

    You may designate your gift to where the need is greatest or to one of HealthEast's hospitals or programs.

    Learn more about our special giving opportunities:

    Prefer not to donate online? Click here for other ways to give through the HealthEast Foundation.

    If you are an international donor, please make your donation by phone at 651-232-4990.

    I want to sign up for the HealthEast Foundation e-newsletter.

  2. Donation Information

  3. Gift designation*
    Select a gift designation.
  4. Other gift designation *
    Enter a gift designation.
  5. Donation amount*
    Select a donation amount.
  6. Other amount *
    Enter a donation amount.

  7. Memorial or Tribute Information (optional)
    Invalid Input

  8. For Shining Star Gifts, please indicate the name, job title, hospital, and floor/unit of the person you are honoring with your gift. If you do not have all that information, provide as many details as you are able.
  9. Enter the information.

  10. Acknowledgment Card

    Please provide the name and contact information of the person who should be notified of your generosity. The gift amount will not be disclosed.

  11. First name
    Enter the first name.
  12. Last name
    Enter the last name.
  13. Address
    Enter the address.
  14. City
    Enter the city.
  15. State
    Enter the state.
  16. Zip
    Enter the zip code.
  17. Enter the message, and your name, as you would like to appear on the card.
  18. Enter a message (Limit 255 characters)
  19. For Donations of $1,000 or More:
  20. Invalid Input
  21. Enter your name.
  22. Invalid Input


  23. Addditional Information



  24. Invalid Input

  25. Billing Information

  26. First name*
    Enter your first name.
  27. Last name*
    Enter your last name.
  28. Address*
    Enter your street address.
  29. City*
    Enter your city.
  30. State*
    Enter your state.
  31. Zip*
    Enter your zip code.
  32. Phone*
    Enter a phone number where you can be contacted.
  33. E-mail*
    Enter a valid e-mail address.
  34. Enter the amount.


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