Donation Request Form

All fields marked with * are required.

Name of Organization / Group *

Primary Contact Person *

Primary Contact Phone *

Email Address *

Organization Mailing Address *

City *

State *

Zip Code *

Website Address

Organization / group mission statement or purpose *

Geographic area or individuals your organization serves. *

Is your organization / group a recognized non-profit entity? *

If yes, please enter your 9-digit EIN / Tax ID number.

Are you or any of your organizational team current GICU members? *

If yes, please describe any personal or business relationships you may have to GICU or any GICU Team Members.

Has your organization previously requested support from GICU? *

Please provide a brief description of the purpose or event for which support is being requested. *

Who will benefit from this request and how will the funds be used? *

How do you feel this request supports GICU's mission of ‘people helping people'? *

Amount being requested *

If there is a funding deadline, please enter it here.

Type of event *

If noted as 'other,' please provide details

Are there volunteer opportunities for GICU Team Members? *

Are there any other ways GICU may provide support (ex: giveaway items, co-op promotion, etc.)? *

What type of recognition, if any, will GICU receive as a result of our support? *

Are there tiered giving/sponsorship levels? If so, please provide what each giving/sponsorship level entails. *

If this is an annual event, what was the attendance last year? *

What is your organization's annual budget? *

If you wish to provide additional support documentation for review purposes, please upload here (2 items, jpg or PDF file format, 2MB max size).

Name