Rock4Reason Donation Request Application
Thank you for contacting Rock4Reason. We understand this is difficult time for your family and we want to make our donation process as simple as possible for you.

The form below will ask a few questions to make sure the donation request falls within our requirements. Once the form is returned, it will be reviewed for recommendation by our Board of Directors. The board meets the second Wednesday of every odd month to review and approve donation requests. You will be notified of the board's decision within 48 hours of the board meeting. To ensure we can help as many families in need as possible, approvals/donations may be limited due to board discretion concerning demand and available funds. The board will only consider one (1) open request per family at a time.

As an all volunteer non-profit, our goal is to answer all requests in a timely manner and within our board meeting schedule. We understand that donation requests may be time sensitive. An email will be returned to you as confirmation your request was received.

Rock4Reason is a 501(c)3 non-profit servicing families in the Northeast Ohio Mahoning Valley area.

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Email *
Date of Request *
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Name of Recipient - Required *
Please give the name of the person receiving the donation.
Address of Recipient *
Contact Information - Required *
Please give the name, address, phone number and email of the contact person for this donation.
Your Story - Required *
Please provide a short description of your story to include with your application.
Residential Qualifications - Required *
Residency and Treatment must be checked. Documentation may be requested to verify eligibility. Please check all that apply.  Ohio Mahoning Valley is defined as Mahoning, Trumbull and Columbiana Counties
Required
Treatment Qualifications - Required *
Residency and Treatment must be checked. Documentation may be requested to verify eligibility. Please check all that apply.  Ohio Mahoning Valley is defined as Mahoning, Trumbull and Columbiana Counties
Financial Qualifications - Required *
The total household income for the person receiving this donation did not exceed the following in 2020. Rock4Reason uses the 100% MRB (Mortgage Revenue Bond) income limit for determination of eligibility. Household income must be determined by adding the income of ALL persons living in the household. Documentation may be requested to verify eligibility.
Required
Primary Purpose for Donation - Required *
Our Organization is required to categorize donations for record purposes. If approved, what would the primary purpose of the donation be used towards? If you have a specific need, or a suggestion for assistance, please do not hesitate to write that in the "Other" line.
Demographics of Recipient - Identity
This section is not mandatory. Rock4Reason gathers this information for reporting purposes and so we can keep our fundraising events relevant to our service base.
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Demographics of Recipient - Age
This section is not mandatory. Rock4Reason gathers this information for reporting purposes. We also can keep our fundraising events relevant to our service base.
Clear selection
How did you hear about Rock4Reason? *
A copy of your responses will be emailed to the address you provided.
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