Donation Request Form

Donation Request

* Indicates required field

Requested Date *

1. Name of Requestor *

First

Last

2. Are you a member of CSDRAA? *

Yes No

3. Email *

4. Videophone *

5. Justification *

6. Acknowledgment *

7. Requested amount *

8. When do you need the money? *

9. Will you accept match up fundraising? *

Yes No

10. Tell us who should we make the check payable to? *

11. Give us where money check should be mailed to? *

Line 1

Line 2

City

State

Zip Code

Country

12. If your company or your donor requires a Federal Tax Identification Number, please use 33-0008762 for donating money or goods to your organization, department or CSDR student(s). You will need to bring this form to the Superintendent's office for approval.

When this request is approved, the students participating with this project and I will agree to send a thank-you letter or video to csdralumni.org explaining how the funds were used and the benefits received from the donation. I also agree to submit the receipts of any purchases made from this donation to the CSDRAA for auditing purposes.

Submit