Application for Charitable Donation

Application for Donation
Thank you for contacting us for your project or event. While we would love to contribute to each request we receive, we allocate most of our funds a year in advance to organizations that we are established with. However, we will consider your request and respond in a timely manner. We will typically respond via email.
Applications must be received at least 2 weeks prior to date needed.
Today's Date

Month Day Year
Date
Approval Needed By

Month Day Year
Date
Organization
Purpose of Organization
Number of Members
Donation Request (Merchandise; Gift Basket; Cash; Etc.)
Who Will The Donation Benefit?
Will Medical Eye Center receive public acknowledgement of donation?

Yes No
If Yes, Please Describe
Other Comments
Please upload any supporting documentation here

Cancel of
Contact Person *
Phone Number *
Email *
example@example.com
Should be Empty:

Application for Donation