donation request form

*Organization Name:

*Contact Name:

*Phone:

*Email:

*Amount Requested:

*Description of Organization:

Deadline if applicable:

Information on event incl date:

Have we donated previously? Yes No

The dollar amount or item we have given in the past:

Please describe in 400 characters or less the offering, sponsorship level or visibility plan provided in exchange for the donation. Please include the value.:

Does the entire donation go to the organization? Yes No

If NO, what percentage do you retain?: