PFLAG
EUGENE/SPRINGFIELD
P.O. BOX 11137 EUGENE, OR
97440
(541) 686-2280
DONATION REQUEST FORM
PFLAG MISSION:
Parents, Families and Friends of Lesbians and Gays (PFLAG) promotes the
health and well-being of gay, lesbian, bisexual and transgender
persons, their families and friends through: support, to cope with an
adverse society; education, to enlighten an ill-informed public; and
advocacy, to end discrimination and to secure equal rights. PFLAG
provides an opportunity for dialogue about sexual orientation and
gender identity, and acts to create a society that is healthy and
respectful of human diversity.
DONATION PHILOSOPHY:
We are pleased to help support organizations which are in keeping with
our mission statement and to form coalitions with other Human Rights
organizations.
What is the name of your
organization?____________________________________________
Is it a non-profit organization? ___yes ___no
What is your mission statement?
_________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
(Attach extra sheet[s] if necessary)
How does your organization fit into our donation
philosophy?____________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
(Attach extra sheet[s] if necessary)
What donation (amount) are you requesting from our
organization?________________________
How do you plan to use this donation? (Be specific):
__________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
(Attach extra sheet[s] if necessary)
What time period do these plans cover? (i.e. school year, fiscal year
etc.): __________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
(Attach extra sheet[s] if necessary)
Are you willing to make a commitment to report back to us at the end of
this time period on how our
donation was used and the results of your project?
___yes ___no
What is the amount of your annual
budget?___________________________________________
<>Name of your contact person:_____________________________________________________
<>
<>Address
_____________________________________________________________________
Phone
_______________________________________________________________________
Email
________________________________________________________________________