Skip to main content
close menu
close menu

Search UK HealthCare

Request for Support

Name and Contact Information of Individual Making the Request
Reason for the Request
Does your organization provide services or support for our patients and/or does your organization provide research funding to UK or UK HealthCare? Yes/No
If yes, please describe how you provide support and dollar amount of funding, if applicable.
Were you referred by someone? Yes/No
If yes, who?
Have you submitted any other requests from other departments within UK HealthCare or the University of Kentucky? Yes/No
If yes, who?

Note: Future consideration requires all organizations to report previous year's results along with submission. All requests will be evaluated based on alignment with UK HealthCare and/or the University of Kentucky strategic priorities.

Unlimited number of files can be uploaded to this field.
256 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.