Donation Request Application
As a 501(c)(3) organization, we are committed to giving back our local community organizations and individuals in financial need to help achieve their goals. Our Local community includes Luzerne County and Wyoming Valley Conference member schools. Please fill out ALL portions of application to be eligible.
Questions, please contact Carlo Mercadante: Helen.Mercadantefoundation@gmail.com or (570) 710-4030.
Business/Organization/Individual Name
*
First Name
Last Name
Organization/Individual Name
*
Contact Name & Number
*
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you acknowledge that not all requests will be granted, and the Helen Mercadante Foundation has no obligation to honor such request
Yes
Do you acknowledge that all INDIVIDUAL requests total amount donated is at the discretion of the board?
Yes
Do you acknowledge that ALL organizational requests have a max monetary amount of $250?
Yes
Has your organization received a donation from the Helen Mercadante Foundation in the past 2 years? Organization may only request a donation every 2 years.
Yes
No
What date does the donation need to be received by?
How will our donation be used? Please Provide ALL details including amount you are requesting and upload any supporting documents below such as camp invites, flyers, registration forms, Organization cover letter, organizational bank statements, quotes, etc Individuals: WE will not fulfill requests for clothing items. Organizations:Please provide individual ITEM request and amount if applicable including any equipment purchases this request may be used for.
*
Please provide the following documents that pertain to you: -Organization Letterhead -Proof of Business/501C -Camp/clinic/sports flyers -Bank statement
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