Domestic Cargo Distribution Report

Organization Name: *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Bill of Lading/Reference #: *

Type of Cargo Received: *

Food Health & Hygiene Humanitarian Aid Pharmaceuticals Mixed Category

Description of Cargo: *

Who distributed the cargo? *

How was the distribution conducted? *

Enter the number of people in each category below who benefited from the cargo:

(0-17) Children *

(18-64) Adults *

(65+) Seniors *

Name the social institutions, hospitals, churches etc. that received the cargo with the approximate number of recipients in each institution or the number of beneficiaries if distributed directly to the public: *

Please provide personal story(ies) of how this cargo benefited the lives of the people you assist so we can share the impact of your program with our donors: *

Think of the story(ies) you tell your friends and family about when you distributed the cargo and how someone was impacted by it.

Please upload distribution and/or program pictures or attach a document with link for shared online photos [Google Drive/OneDrive/icloud, etc.]. If you are unable to share photos at this time, please attach a document with explanation: *

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* I hereby grant permission to World Emergency Relief and its affiliates, the right to use the visual and/or audio recording and still images provided without payment or other consideration. By signing this form, I understand that these images/recordings may be used in print or electronic form for educational and promotional purposes.

Digital Signature *

Title *

Email *

example@example.com