In-Kind Donation Form 2020

Donor Information:

Date

First Name

MI

Last Name

Organization/Business Name:

Donor Phone

Donor Email

Address Line 1

Address Line 2

City

State

Please select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code

Donation Details:

Description of donation item(s):

Estimated monetary value of donation item(s):

Program receiving donation:

Please select... After School/Summer Programs Diaper Bank Early Head Start Financial Services Gardening/Nutrition Head Start Home Rehab/Repair Homeless/Housing Services Marketing/Events Other

If other, please specify the program receiving donation:

Name of staff member accepting the donation: