Ashro’s Community Giving Request Form Tell Us About Your Organization! Please fill out the form below letting us know more about your organization and how we can help! Organization NameContact Name First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneWebsite Facebook Page (if applicable)General description of organization’s mission and purpose:Is the organization recognized as 501(c)(3)? Yes No Date Organization was Established:How would awarded funds be used? Be sure to include any project work and how the funds will benefit specific projects.What percent of your organization’s dollars that stay local to your home community?What % of the contributed dollars go toward administration?Who will directly benefit from the funds and/or projects? Include a description of community stakeholder groups that your organization supports.What geographical region will the funds and/or project impact?What are your urgent needs at this time?Would you be interested in in-kind donations? What type of equipment/items would you be interested in receiving?Any additional information you would like us to consider?