Donation Information Request
Organization Name
*
Request Information
Amount Requested
*
Date Needed By
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Type of Request
*
Please Select
Grant
Sponsorship
Other
Is your request for an event?
*
Yes
No
Project Name
*
Event Name
*
Event Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Event Venue
*
Venue Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How will the funds be used?
*
Beneficiaries
Who will benefit from this funding?
Children
Youth
Families
Seniors
Veterans
Individuals with disabilities
Survivors of domestic violence
Low-and moderate income individuals
Small businesses
Other
Briefly describe the population that will benefit from this funding
*
How many people would this donation benefit?
*
Precise number if possible
Would this donation primarily benefit low-income individuals?
*
Yes
No
What percentage of beneficiaries would be low-to-moderate income (LMI)?
*
LMI: less than 80% of the Area Median Income. Precise percentage.
Funding Recognition (If Applicable)
What benefits would the bank receive from this donation?
*
Advertising
Dinner Attendee
Tickets
Other
None
If "Other" please specify
*
How much of the requested funding will be used to provide benefits, recognition, advertising, tickets, or other value to the bank rather than directly supporting the organization's programs or services?
*
e.g., meals, golf round, tickets, advertising, etc.
Additional Opportunities
Does your organization have a need for any of the following?
*
Board members
Financial education workshops
Service projects
Volunteers
Other
None
Please specify
*
Requestor Information
Name
*
Title
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Submit
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