Supplier Diversity Vendor Application

Instructions: Suppliers, contractors and providers complete all sections that are applicable, date and submit.

  • References

    Please provide the name, address and phone number of two corporations for whom you have provided services in the past 12 months.
  • Contact Information

  • Optional Information

  • Supplier Diversity Program Information

    Please complete this section if you are a certified veteran owned small business (VOSB), minority owned business (MBE), or a woman owned business enterprise (WBE). The intent of the UC Health Supplier Diversity program is to increase the amount of goods and services purchased from certified VOSB, MBE, and WBE vendors.
  • Attachments

    Please attach the following: If you are a Certified Diversity vendor, please attach your current certificate from that Certification Agency. Also, please attach either marketing material or a brief description of your business to help us understand your products or services specific to Healthcare. You may attach up to 3 documents to your application. Attachments may be in Adobe PDF, Microsoft Word, Microsoft Excel, Microsoft Powerpoint, or plain text format only. Each attachment may be no larger than 2MB. Attachments that do not conform to these guidelines will be ignored.
  • Max. file size: 2 MB.
  • Max. file size: 2 MB.
  • Max. file size: 2 MB.
  • Submit Application

    When all sections are complete, press the "Submit" button.