Essentials Drive Interest Form

HomeAid North Texas Essentials Drive Interest Form

Most Essentials Drives are half-day events. HomeAid North Texas strives to provide these at no cost to our service provider partners, but that cannot be guaranteed. Costs will be figured out together ahead of time. To be considered, we must have all of the information requested below before the first meeting with leadership of both organizations.
Section 1: Organization Information
Essentials Drive
Tax ID Number*
Organization Name*
Organization's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Organization Website*
Primary Contact*

First NameLast Name
Primary Contact Phone Number (Mobile Preferred)*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Contact Email*
example@example.com
Section 2. Who Do You Serve?
Organization's Mission Statement
Abused ChildrenAdults - Substance AbuseAdults w/AidsChildren/YouthChronic HomelessDevelopmentally DisabledDomestic ViolenceEmancipated YouthFamiliesHuman TraffickingKinshipMenOlder Adults/SeniorsPregnant Minors and their childrenReentry/Second ChanceSex Trafficking VictimsVeteransWomenWomen and ChildrenYoung Adults 18-22Youth with DiabilitiesOther
HousingOutreachCase ManagementAddiction RehabilitationMental Health ServicesHIV/AIDS-related programsEducationEmployment AssistanceChildcareTransportation AssistanceLegalLife SkillsOther
How many clients do you serve annually?
Government FundingGrantsCorporate DonorsIndividual DonorsSpecific FoundationsOther
Section 3: Our Needs
Essentials Drive

"Essentials" below refers to CareKits: hygiene kits, nutrition kits, etc.
DiapersWipesCoatsHatsGlovesBlanketsSocksUnderwearEssentialsBackpacks/School SuppliesMiscellaneousOther
Section 4: Resources
YesNoPartial
Thank you for your application!

We look forward to speaking with you soon. For questions or comments, contact HomeAid North Texas Executive Director Scott Sheppard at scott@homeaidnorthtexas.org or 817-944-8989
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HomeAid North Texas Essentials Drive Interest Form

Section 1: Organization Information

Section 2. Who Do You Serve?

Section 3: Our Needs

Essentials Drive

Section 4: Resources

Thank you for your application!