Inkind Contribution Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Are you a student in an active Practicum or Internship with Family Service of El Paso?*

YesNo

School Name*

School Point of Contact *

First NameLast Name

Reporting Month

Contribution Type*

Are you providing pro-bono Professional Counseling Services as an LPC-A ?*

Please list the professional services you have provided at no charge.*

Are you representing a company or an organization?*

Name of the Company*

Donated Items Table*

Please enter the number of Direct hours contributed during the month selected above:*

Please enter the number of Indirect hours contributed during the month selected above:*

Please make short description of volunteer services you provided for Family Service of El Paso:*

Please enter the total amount of volunteer hours contributed during the month selected above:*

Will you require approval or signature of a time card or timesheet for your institution?*

YesNo

Please Select Time sheet/Time card Submission choice*

Please paste the URL link your institution's Timesheet approval platform.*

Please Upload Your Institution's Timesheet*

Total Fair Market Value of goods or services*

I understand that practicums/internships do not pay students. I attest that the hours completed were supervised by a licensed professional and any feedback provided by the supervisor offers practical experience which will help me learn the ins and outs of working in the field, including what it's like to apply theories they learn in class to real people. I understand that the serviced hours count as an in-kind contribution to the organization. I understand that the calculated hours are based on the cap cost of a counseling session provided by Family Service of El Paso.*

I accept & Agree

The services provided are subject to review for accuracy and completeness to verify they are eligible as inkind contributions.*

I accept & Agree

I understand and agree that the calculated fair market value of my volunteer hours was based on a estimated value that is reasonable. FSEP used its calculation based on the data provided by 'THE INDEPENDENT SECTOR' an organization dedicated to gather data. In its newest Value of Volunteer Time report, Independent Sector, with the Do Good Institute, announced on April 19, 2023 that the latest value of a volunteer hour is estimated to be $29.80 in Texas in 2022.*

I accept & Agree

I understand that the calculation of the value of my in-kind gift, was calculated by subtracting what it would have cost to buy or produce the item new from its fair market price. If you donate clothing or household items which are not in good condition, the IRS may reduce their value to what you could sell them for. I am confident that my calculations are fair & reasonable.*

I accept & agree

Signature*

Inkind Contribution Form

Professional Services