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?
How did you hear about Olive Motherhood Foundation?
The following questions are regarding the intended donation recipient:
Age & Gender of recipient(s):
*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):
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)
*