GOODS PROGRAM APPLICATION

Form
Name

First NameLast Name
GOODS Program Application

This application is needed to apply for donations from the GOODS Program through Great Good Charities. Donors provide wholesome, nutritious food on an as-available basis only. GOODS Program and recipient organizations are not able to request specific food types (e.g., grain-free etc) or specific brands Food and supplies (the "Donated Goods") are the Recipient Group's use only. They may not be: a) redistributed without the expressed written consent of GOODS Program, b) sold, rented, or exchanged for other goods or services, no c) presented for refund. Each Recipient Organization must complete their own application. Submitting this form does not guarantee approval to receive product. Incomplete applications will not be processed.
Email Address: Note this will be the email address we send all correspondence to
example@example.com
You are applying as a

Animal Rescue/Shelter/Animal Control or other animal servicesFood Bank (Animal)Food Bank (Human)Other Human Services
Organization Name
Website:
Website link to adoptable animals (i.e. Petfinder etc)
Facebook Page
Guidestar Profile Link
Non-Profit Tax ID Number
Address (not a PO Box) Include City State and Zip
If Animal Program where do your animals reside

FosterShelterBothOther
If other, please explain:
FOR ANIMAL PROGRAMS. Human Services Skip to next section.
# of DOGS adopted past 12 months
# of CATS adopted past 12 months
Average monthly need for food (lbs)
Describe your food storage capabilities. Include maximum food storage capacity
Do you spay/neuter all animals prior to adoption? If no, explain why.
# of employees?
# of active volunteers?
Does your organization have a contract to provide Animal Control Services for any City, County, or Municipality? If yes please explain
Have you participated in a "donated" or "low cost" pet food program within the past (12) months? If yes, please explain (example: Hill's Program)
List your current food sources
Why is your organization requesting support from the GOODS Program?
Provide your Veterinarian's Contact Information. Note: we will be contacting your Vet for a Vet reference.
Complete for both Human and Animal Services
Completed by (Applicant)
Applicant's position in the organization
Applicant's phone number
By submitting this application you agree and acknowledge the following terms and conditions:
1. You are authorized to sign this agreement on behalf of this organization and certify that the information set forth in this application and supporting documentation is correct.

2. You have read and understood the criteria that apply to this application and certify that the group meets each one.

3. The IRS determination letter has not been revoked, canceled or modified.

4. That food shall be protected against dampness, deterioration, and mold or from contamination by insects, birds, rodents or other animals

5. That food spoiled or otherwise contaminated shall not be served.

6. To abide by restrictions or conditions of distribution, if any, imposed by the source of Donation and communicated to Recipient by Donor.

7. Any raw meat provided is not fit for human consumption and shall be used solely for feeding animals.

8. That feeding pet food to ruminant animals is prohibited.

9. To not sell, transfer, trade or barter any Donation or portion thereof in exchange for money, property or services or otherwise allow the items to enter commercial channels.

10. To release both Donor and Donor’s source(s) from any liability arising from the condition of Donation and further agrees to indemnify and hold harmless Donor and its source(s) against any and all damages, losses, claims, causes of action and suits of law or in equity or any obligation whatsoever arising out of or attributed to any action of in connection with Recipients receipt, handling or distribution of Donation.

11. That the GOODS Program may list your organization as a participant in its publications, website or other informational materials but will not sell or disclose non-contact information for any commercial purpose.

12. That goods or services are provided on an "as is" and "as available" basis. The GOODS Program expressly disclaims all warranties of any kind, whether express or implied, including, but not limited to the implied warranties of merchantability or fitness for a particular use or purpose.

13. Your organization grants to the GOODS Program the following: 1) the right to include on its website a link to your organization’s website(s), 2) the right to use any image(s) that you submit to the GOODS Program or that may be recorded by the GOODS Program during or in connection with events that involve both organizations.

14. Permit monitoring, including a site visit if requested, by a Donor representative, as reasonable and necessary to verify that compliance with criteria, receipt, handling and use of Donation conform to this Agreement.

15. Applicant grants permission to the GOODS Program and its pet products donors to use information contained in this application for their internal evaluation and response procedures.

16. All handling fee payments are to be made payable to the Affiliate Organization or the GOODS Program, as requested, and in no event made to any individual or other organization.
I have read and agree to the terms and conditions described in this application

Yes
Please attach a copy of your IRS Determination Letter or email to kc.paws@hotmail.com

Cancelof
How did you hear about our program? (If you were referred, please list the name of the individual and/or organization.)
Please list at least one reference who you have worked with or who is familiar with your program. (i.e. rescue or shelter or human services organization).
What's next?

The Kansas City Ambassador will move forward with processing your application. For questions, please email kc.paws@hotmail.com. The process could take up to 2-3 weeks and additional questsions may need to be answered. If approved, you will receive an eail with information about our next distribution date and how to proceed for there.
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Form

GOODS Program Application