Date of Proposal:
Your Name:
Is this a request that:
Organization:
Personnel Contact at Organization:
Mailing Address:
Method Of Donation Payment:
Payment Details As Required Above (i.e., link, mailing address or email & contact name:
Donation Amount Requested: $
Charitable Registration Number:
Organizations Website:
Mission/Vision/Values of the Organization:
Programs & Services Provided by the Organization:
Rationale for the donation:
Strategic Plan Areas:
Donation Requests are fielded once a month at the regularly scheduled Executive Meeting.
Requests will not be considered if any fields on this form are left blank.
Your form submitted successfully!
Sorry! your form was not submitted properly, Please check the errors above.
