Disabled Automobile Assistance Form

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On Campus Mom Foundation

Email *

Form Completion Date:
*

YYYY

Name of Assistance Provider: *

Address: (City and State) *

Phone number: Cell (add home if applicable) *

Affiliation with Baylor University: *

Parent

Alumnus

Local to Waco

Required

I am willing to provide assistance due to disabled automobile within the following radius of my location: *

0-25 miles

26-50 miles

51-75 miles

76 to 100 miles

100+ miles

Submission of Identification:

Please kindly transmit an image of your state issue ID under separate cover after submission of this form to: Volunteer@ocmfoundation.org. Transmission of this document will be utilized to better facilitate the initial physical contact with the assistance provider and student.

I will be submitting an image of my state issued ID to: Volunteer@ocmfoundation.org

I will not be sharing my ID with The OCM Foundation, Inc.

Compensation for Assistance:

I agree it is my responsibility to provide The OCM Foundation, Inc. a valuation of contribution for the assistance provided to facilitate the release of a letter of contribution.

Yes

The OCM Foundation, Inc. will serve as a bridge to connect students and/or a student's family who is in need of assistance by the provider as listed above. I, the individual(s) listed above, does hereby grant permission to The OCM Foundation, Inc. to share my information when a need arises.

Yes

Comments

A copy of your responses will be emailed to the address you provided.

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