Donation Request Form

Name(Required)

First Last

Tribal ID #(Required)

Name of Organization

Status of Organization (please provide Tax Id #)

Address

Phone

Fax

Contact Name

Title

Title of Event

Event Date(Required)

Date to receive funds by

Please explain the purpose of your request and who it will benefit (Please attach any donation request letters that you may have on your organizations letterhead)(Required)

What is the total amount needed to fulfill your request? (Please attach any budgets that you may have)(Required)

What amount are you seeking from the Cahuilla Band of Indians Aid to Local Government?(Required)

If request is granted, check can be made payable to (please provide address):(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Organization

Memo

W-9 form

Max. file size: 50 MB.

Name of Requestor(Required)

Date submitted(Required)

For Cahuilla Band of Indians use ONLY (below the line):

STAFF: