COALITION PARNTER FORM

ILM and the Coalition to Preserve Human Dignity is celebrating, 25+ consecutive years of coordinating Humanitarian Day.

The purposes of this form is for ILM to learn if your community is interested supporting the annual Humanitarian Day Ramadan Campaign.
GENERAL INFORMATION
Date

MonthDayYear
Date
Organization Name
Organization Website
Does your organization have a 501c 3 tax exempt status?

YesNo
Representative Full Name
Representative Email
example@example.com
What gift item is your organization interested in contributing?

FoodWaterShirtsSocksHygiene KitsFemine Care KitsBackpacksPonchosOther
Is your organization interested in making a gracious cash donation?

YesNo
Is your organization interested in making a gracious in-kind donation?

YesNo
What services is your organization interested in providing?

Health screeningHair cuttingNutritionReferral servicesUplifting feedbackEducational learningProject managmentMarketing and promotionCommunity ServicesOther
What equipment are your interested in providing?

TentsTablesChairsDolliesOther
Please list below possible additional partners and funding contacts:
Do you agree to join the Coalition to Preserve Human Dignity in support of ILM's Annual Humanitarian Day Ramadan Campaign?

YesNo
Please upload your organization's logo

Cancelof
THANK YOU
Should be Empty:

GENERAL INFORMATION