Charitable Donation Request Form

The goal of The Drake Durkee Foundation is “To inspire, educate and motivate children to realize the impact of intentional acts of kindness and to empower kids to proactively create an environment of inclusiveness for all children” As a part of realizing this goal, The Drake Durkee Foundation is accepting applications for donations for individuals and organizations who have the same goals in mind.

Please fill out the below form. A board member will review your application and reach out to you.

APPLICANT CONTCT INFORMATION

Will this be for an individual or organization?

Applicant Name

First Name

Last Name

Applicant Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Applicant Phone Number

(###)

###

####

Applicant Email Address

Organization information

If you are an individual requesting a donation, skip the next four questions

Organization Address

(If Different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Organization Phone Number

(If Different from above)

(###)

###

####

Organization Website

http://

Organization Mission Statement

Between 1-4 sentences about the organization

FUNDING INFORMATION

How will the funds be used?

Check all that apply

Day-to-day supplies

Organization administrative costs

Reoccurring event funding

One-time event funding

Educational finding

Misc. (Please give more information In the "Additional Information" section below)

What is the demographic (ages, location and interests) of the people the rewarded funds will benefit?

Amount Requested?

Any additional information you would like the foundation to know?