Community Spark

Reliant Donation Request Form

Information submitted using the form below is confidential and the form is a secure transmission method.

Organization's Details

Tell us about your organization.

Organization name

EIN

Website

Phone Number

Address

City

State

Postal Code

What is your organization's purpose?

Is the organization a 501(c)(3)?

Yes

Primary Contact Details

If we have questions, who should we contact?

First Name

Last Name

Title

Phone

Address

City

State

Postal Code

Program Name

Program Date

Amount Requested

Funds Needed By

Program Type

Intended Use of Funds

Please provide a detailed description of the program. Including, who will benefit from the funds, how it will impact the community and specific programs or services provided.

Sponsorship Benefits And Notes

IF ANY, PLEASE LIST ALL SPONSORSHIP BENEFITS, INCLUDED BUT NOT LIMITED TO: BANNERS, PROGRAM RECOGNITION, ADVERTISEMENT, BOOTH SPACE, ETC.

What areas of the community would be most impacted by your project?

Attachments

organization

EIN:

primary contact

Email:

program

Requested Amount:

Needed By: