Donation Request Step 1 of 3 - Contact Information 0% Please complete this form and submit for review. Name of Organization*Contact Person*Address Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Date* Amount Requested*Purpose of Donation*Is this a tax exempt organization?*YesNoTax Exempt Designation*Exemption #* Do other outside sources fund this organization?YesNoPlease ExplainWill any part of these funds be used for administrative purposes?YesNoPlease ExplainIs there a critical date that these funds must be received by?YesNoPlease Explain This iframe contains the logic required to handle Ajax powered Gravity Forms.
