OMF Donation Request Form

Please note, donations are not guaranteed upon request. Donation forms are reviewed and allocations are carefully considered by the OMF Board of Directors. Your thorough response to each of the below questions helps influence discretionary opinion. This donation form is kept confidential and shared only among authorized foundation members or upon expressed written consent by the submitting request party. 

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Date *
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Name of individual submitting form:

Name of individual to receive donation, if different than above:

*

Describe your relationship to the intended recipient: 

Contact phone number:

May Olive Motherhood Foundation (OMF) leave a detailed voicemail?

Contact email address:

How did you hear about Olive Motherhood Foundation?

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The following questions are regarding the intended donation recipient:

Age & Gender of recipient(s):

*
Marital status: 
*

How many people are living in the household? (include the total number of people living under one roof)

Estimated annual household income (include the total income of all the people living under one roof):

Please list all government programs 

Is this donation intended to benefit a child or children in the household? Please provide detailed description:

How many years has this individual or family lived in Williston?

*

Current employer  (if no current employer, list date and company name of last two employers)

*
What donation needs are being requested?
*
Thank you for completing this donation request form. Please allow up to one month for processing. 
All requests must be approved at board meetings which are one time per month. Each board meeting takes place the second Thursday of the month. 
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