Milk Drop Depot
Thank you for your interest in becoming a Milk Drop Depot partner with Mothers’ Milk Bank Southeast. Milk Drop Depots play a critical role in increasing access to safe, pasteurized donor human milk by serving as approved collection sites for screened milk donors. Please complete the application below. Submission of this application does not guarantee approval. Applications will be reviewed based on geographic need, organizational capacity, storage capabilities, and alignment with Mothers’ Milk Bank Southeast policies and procedures.
Organization's Name
*
Primary Contact that will serve as Milk Drop Depot Director
*
Title
*
Cell Phone Number - in case of emergencies (will only be accessible to Milk Bank leadership and courier)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number You Wished to Be Published for Donors to call to schedule a drop-off appointment.
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where will the freezer be located (e.g., clinic lobby, lactation room, pharmacy)? Please describe space, accessibility and security.
What days/hours will the Milk Drop Depot be open for donors to drop off milk?
Who will be responsible for checking and recording freezer temperatures?
Signature
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