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IMPORTANT: PLEASE READ BEFORE PROCEEDING

By completing and submitting this application for the NRHA Rural Hospital Partnership Program, you’re expressing your interest in joining us. We encourage you to submit the application if:

  • You have reviewed all partnership details and requirements.
  • You are prepared to discuss the partnership contract upon approval.
  • You are genuinely interested in exploring a partnership with NRHA.
Acknowledgement

Your Information

Name of person completing the application

Organization Information

Address
Name of person to sign the contract (Ultimate Decision Maker)
Name of selected rural health expert to represent your organization?
This person must have a baseline familiarity with rural hospital buying cycles, culture, and ability to speak the unique healthcare language.
Are you currently developing or have developed educational content focused on RURAL HEALTHCARE?
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How many rural facilities is the company currently working with now?
Which one best describes the company?
Does the company have an internal marketing department?

Rural Healthcare References

Upload your references document below.

Please note: Only hospital or clinic references will be accepted. We require a minimum of 12 references.

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