Belmont Athletics Donation Request Form

Requester Information*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Organization Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Organization Classification (check one)*

Elementary/Middle/Junior High SchoolHigh School (Grades 9-12) / Preparatory School / Junior CollegeNon-Profit / CharitableOther

Please indicate the grades available at your school.

Elementary/Middle/Junior High School

Please describe.

Requests from Non-Profit Organizations must be accompanied by documentation of its 501(c)(3) status and documentation describing the fundraising event in which the item will be used.

Name of Event*

Date of Event*

Date

Event Location & Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing address for donation item is the same as the organization address.*

YesNo

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

NCAA guidelines require the following conditions be met in regards to institutional memorabilia and autographs.

1. An institution (or an institution's coach/staff member or representative of its athletics interests) may contribute to a nonathletically related bona fide youth organization that includes prospective student-athletes and nonprospective student-athletes, provided the assistance is not earmarked for a particular student-athlete, is not earmarked for the purpose of contributing to a boys' basketball program, and is offered in conjunction with the organization's regular fundraising activities. Prospect age is defined as grades 9-12 for all sports.

2. All profit from the promotions activity or project must go directly to the requesting charity, non-profit agency or educational institution.

I have read the above NCAA guidelines and agree to adhere to them if my donation request is approved.*

Yes, I agree.

Currently all approved donation requests are being fulfilled with:

10 Flex Ticket Vouchers for Belmont Basketball (may be used for men's or women's games).

Please allow two (2) weeks for processing.

For Office Use Only:

_____ Approved _____ Denied

Staff Member: _________________________ Date: _____________________