Donation Request

Donation Request

File Upload*

Please upload the organization W-9 and any relevant documents pertaining to your request. If the request is $5,000 or above Form 990 must also be uploaded.

Drag and drop files here or

Please Ck this box if you have uploaded the Org W9 and are ready to complete the request.*

SCUCU cannot consider any donations without a W9 being provided at the time of the request. Failure to provide a copy of this document will result in a decline of the donation. If you need time to obtain and provide this document, please come back when it is available to make your request.

Organization Name*

Primary Town/City or County of Benefit (One Town/City or County only please)*

State - Please note SCUCU does not contribute outside of its local area of MA & RI*

Select

Organization Mission Summary - Please summarize and keep brief

Is the Organization a 501 (C3) or 501 (C4)?*

Yes

What is the percentage of funds from this donation that would be used for the cause?*

This is the percent that goes directly to the assistance of others after any administrative and similar costs

Amount Requested*

Event Name

Sponsorship Options, if any

Organization Physical Address*

Full Mailing Address (#, Street, Town/City, Zip)*

Contact Name*

Email Address*

Phone Number

Phone

Check Payable To, if Approved*

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