WNC Community Partner Request Form
** DBNC is currently scheduling deliveries for late August and September. Please submit your order and we will be in touch soon to schedule a delivery. If you have questions or need more information, please reach out to DBNC's Chief Operating Officer Jannice Verne at jannice@ncdiaperbank.org.**
Who is Diaper Bank of North Carolina?
Diaper Bank of North Carolina (DBNC) is a state-wide nonprofit distributing diapers, period products, and adult incontinence supplies to families experiencing poverty and natural disasters. Half of families in North Carolina do not have the diapers and hygiene products they need to thrive, and there are no government-funded programs that provide assistance with these items. DBNC partners with hundreds of nonprofits and state and county agencies to distribute these needed supplies to families in need.
Who Can Use This Order Form?
This order form should be used by nonprofit organizations and state and county agencies serving WNC and families affected by Hurricane Helene. The diapers and hygiene products distributed by Diaper Bank of NC and it's partners must be provided to families free of charge or obligation. Diapers and hygiene products distributed by Diaper Bank of NC may not be sold, traded, or bartered. If you are an individual who needs assistance, please send us an email at info@ncdiaperbank.org to be connected to a Community Partner.
What Happens Once I Submit This Form?
Once you submit your completed order form, DBNC staff will review it to confirm your organization’s eligibility to receive diapers and hygiene products, as well as the availability of the requested items. Depending on the your location (and the products requested), we may connect you with another diaper bank in your area to fill your request. If we have any questions about your request, we may reach out for clarification, so please ensure you provide as much contact information as possible.
Organization Name
What counties does your organization serve?
Organization Contact Name
First Name
Last Name
Direct Line for Contact Person
*
-
Area Code
Phone Number
Contact Person's Email Address
example@example.com
Delivery Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When can this site accept deliveries?
Please indicate the number of children wearing each size diaper.
Number of CHILDREN
Preemie (up to 6 pounds) LIMIT 4
Newborn (up to 10 pounds)
Child Size 1 (8-14 pounds)
Child Size 2 (12-18 pounds)
Child Size 3 (16-28 pounds)
Child Size 4 (22-37 pounds)
Child Size 5 (27+ pounds)
Child Size 6 (35+ pounds)
Child Size 7 (41+ pounds)
Toddler Pullup 2T/3T (16-34 pounds)
Toddler Pullup 3T/4T (32-40 pounds)
Toddler Pullup 4T/5T (38-50 pounds)
Goodnights and Underjams. Indicate gender (Please know we will do our best to honor gender but cannot guarantee we will have them in stock).
Number of Packs
Gender
Small/Medium (38-65 pounds)
Large/X-Large (64-125 pounds)
XL (125+ pounds)
Baby Wipes
How many children are you requesting supplies for? (one item per child, per month)
Baby Wipes
Baby Formula and Feeding Supplies
If you are looking for a specific brand of formula, please let us know in the notes section below.
Baby Formula and Feeding Supplies Request
How many children are you requesting supplies for? (one item per child, per month)
Ready to Feed (Liquid) Formula
Powdered Formula
Baby Bottles
Do your families need a particular brand of formula? Please let us know below. The flyer above has the brands and expiration dates for the formulas we have the most supply of, but let us know if you are looking for a specialty formula not listed and we can check our inventory.
Period Products
1 in 3 North Carolinians struggle to purchase period products due to lack of income. Period Power is Diaper Bank of North Carolina's initiative to improve access to period products for menstruating individuals in our community.
Period Products
Number of Individuals (period products are packaged in packs of 10)
Pads
Liners
Tampons
Adult Incontinence Supplies
For seniors on limited income, adult incontinence supplies can be a luxury item. Diaper Bank of NC distributes this basic need through Community Partners who have applied to receive these items.
Adult Incontinence Supplies. Limit of 30 packs per style per month. ***Limited Tabs***
Item Needed
Pull-Up Style
Tab-Style Briefs
Number of Packs Needed
Small/Medium (28-42 inch waist)
Medium (28-40 inch waist)
Large (38-50 inch waist)
X-Large (48-64 inch waist)
XX-Large (64-80 inch waist) **LOW INVENTORY**
Incontinence Pads
Men's Guards
Adult Wipes
Bed Pads
Notes
Submit
Should be Empty: