Community Contribution Request Form
INSTRUCTIONS:
This request form must be completed in its entirety. Incomplete forms will not be considered. Please attach or include any additional documents/flyers related to the contribution request, if applicable.
REQUESTOR INFORMATION
Organization Name:
*
Contact Name:
*
First Name
Last Name
Phone:
*
Format: (000) 000-0000.
E-mail:
*
example@example.com
Physical Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different from above):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Type / Tax Status:Nonprofit 501(c)(3), government entity, school, for-profit, individual, other
*
501(c)(3) Nonprofit
Government / Tribal Entity
School / Educational Institution
For-Profit Business
Individual
Other
EIN / Tax ID (if applicable):
Is this organization a CDFI, MDI, or minority/women-owned business?
*
Yes
No
Unknown
Does the Organization or requesting individual have a current relationship with Denali State Bank?(e.g., deposit account or loan)
*
Yes
No
Has Denali State Bank contributed to your organization in the past?
Yes
No
If yes, provide date(s) and amount:
*
Back
Next
REQUEST INFORMATION
Type of Support Requested:
*
Monetary donation / grant
In-kind donation (goods)
Bank staff volunteer time / service*
Other
*If bank staff involvement is requested (teaching, board service, technical assistance, etc.), please describe:
*
Who does this contribution primarily serve? (select all that apply)
*
General public
Youth or seniors
Low- or moderate-income individuals/families
Small businesses or farms
Persons with disabilities
Other
Approximate number of people benefited:
*
Contribution Amount Requested ($):
*
Event Start Date/Time (if applicable):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Description of Request (i.e., what are the specific details of the contribution request):
*
If approved, how will the contribution benefit the organization and the community?
*
If approved, how will our contribution be acknowledged? (e.g., logo on website, social media acknowledgment, banner, etc.)
*
Please attach or include any additional documents/flyers related to the contribution request, if applicable.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
ACKNOWLEDGMENT
I have read Denali State Bank's Community Contribution Program Guidelines and understand that this request is not guaranteed. Furthermore, I confirm that this request meets the criteria as outlined in these Guidelines.
X Signature
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: