CHARITABLE DONATION REQUEST FORM

The following information is required for Pennsylvania Skill Charitable Giving to consider your request:

A description of your organization, including its mission and major accomplishments.
A copy of the letter from the IRS stating your organization's 501(c)(3) status and W9 form.
A list of key staff and titles and current Board of Directors including officer status.
Please note the donation cycle occurs monthly, starting on the 15th of each month.
If the request is over $2,500*, a quote is required for items and/or equipment to be purchased.
- *If the request is over $5,000, please provide three (3) competitive quotes.
All sections must be completed; please enter "None" where not applicable.

Contact Information

Date:*

Date

Organization:*

Is this a 501(c)(3) IRS Approved Charity?:*

YesNo

EIN number:*

Contact Person:*

Title:*

Email:*

example@example.com

Cell Phone:*

Address:*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Organization's Phone Number:*

Contact's Relationship to Organization:*

EmployeeVolunteerPaid WorkerFund Raiser

Who referred you to apply:*

Donation Request

Please specify how much the donation is you are seeking:*

Date Requested By:*

Date

*If the request is over $2,500, a quote is required for items and/or equipment to be purchased. If over $5,000, provide 3 competitive quotes

*Please submit no less than 30 days before contribution is needed. Incomplete or late proposals may not be considered.

Have you previously received a donation?*

YesNo

Date Donation Received*

Date

How will the donation be used:*

To whom should the check be made payable:*

Where should the check be mailed to:*

Will you accept partial funding?*

YesNo

About the Organization

Services your organization provides*

How will your organization specifically recognize PA Skill Charitable Giving in addition to a thank you letter with details about your project? *

Social posts local media posters in location etc

In what cities/counties does your organization provide services*

Who is your local House Representative*

Local Senate Representatives*

Search to Find local Representative Here

Your Website*

Organizations Social Media*

Applicant/Officer Signature & Title:*

Printed Name*

Date*

Date

Additional Signature of Agreement to Product Promotions for PA Skill. By signing below, you consent to the use of photographs related to this donation for promotional purposes, including but not limited to posting on social media platforms.