Charitable Donation Request Form

Please fill out all of the below fields. In the brief description of your event near the bottom, please include information on who benefits from the funds raised and how the funds will be used.

This HTML form was created by Freedback.

If you have any questions, contact [email protected].

Legal name of requesting organization:
Organization type:
Affiliation with the Dash
501 (c)(3) non-profit U.S. tax ID number:
Organization's address:
Organization's city, state and ZIP:
Name of contact person:
Contact person's email:
Daytime phone number:
Number of attendees at event:
Fundraiser event name:
Fundraiser event date:
Fundraiser event location:
Fundraising goal ($):
Brief description of your event:
Donation item(s) will be used for: