Donation Request Form

Donation Request Form

This form is for requesting a donation from LFC.
All the following are required to receive a donation from LFC.
- A valid and current photo ID (expired IDs are not accepted)
- Must be a resident of any of the following counties (Monterey, San Benito, Santa Cruz)
- Why do you need a free device, and why can you not purchase one?
- Must have a current and approved LFC application on file (applications are valid for one year after submission)
All requests that do not meet these requirements will not be approved.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
What Organization do you work for? If unemployed enter NA.*
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many people are in your household?*
Adults (over 18)*
Children (under 18)*
What kind of services do you receive, if any?*

Cal WorksDisabilityHousingEBTUnemploymentCash AidChild SupportOther
How did you find out about us?*

Word of MouthFacebookInstagramGoogleCraigslistFair or FestivalOnlineOther
Are you or anyone else in your household enrolled in public school in Monterey County?

YesNo
If yes how many.
Are you staying in a motel/hotel?*

YesNo
Are you staying in a shelter?*

YesNo
Are you staying in a car?*

YesNo
Other? Please Explain.
Is anyone in the home employed?

YesNo
Have you received food from the food pantry within the last 2 weeks?*

YesNo
Do you currently have a computer?

YesNo
If yes, what is the primary use of the computer?

PersonalHomeworkWeb SearchEmploymentOnline Chat
We the people of LFC understand that at some point in our lives we go through situations that we never thought we would go through. Many people in our community need help but it is impossible to help everyone. We keep our records confidential so we would like for you to keep this confidential. Do you agree?*

YesNo
In a short paragraph, please explain your situation and explain your hardship. Keep it short and simple.*
Signature*

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Photo Identification*

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