Donation Request Form
Name
*
First Name
Last Name
Organization Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Timeline/Deadline: When is the donation required?
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cause or Event Details
Description of the Cause or Event: A brief explanation of what the donation will support. Be specific about the cause, project, or event.
*
Goal or Objective: What is the ultimate goal of the cause/event? How will the donation help achieve this goal?
*
Date of Event (if applicable):
*
-
Month
-
Day
Year
Date
Donation Request
Requested Donation Amount: How much money is being requested or what type of donation are you seeking (money, goods, services)?
*
Donation Purpose: How exactly will the donated funds be used (e.g., for operational costs, scholarships, supplies, event costs, etc.)?
*
Donation Levels (if applicable): If you are seeking donations at different levels, upload this information or include in the open text box below.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you or anyone representing the organization have any direct or indirect ties to Empire?
*
Yes
No
If yes, please describe the nature of the relationship:
Tax-Exempt Status (if applicable)
Is your organization a 501(c)(3)?
*
Yes
No
Additional Information
Supporting Documents
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional Information: Any extra details that will be helpful for our decision-making process (e.g., references, past donations, partnerships, etc.).
Submit
Should be Empty: