PFLAG
EUGENE/SPRINGFIELD
P.O.
BOX 11137
EUGENE,
OR 97440
686-2280
GSA
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 Gay Straight Alliances in Lane County.
What
is the name of your school?
_____________________________________
What
donation (amount are you requesting from PFLAG? ________________________
How do you plan to
use this donation? (Be specific):_________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
[attach sheet(s) if necessary]
What
time period do these plans cover? (i.e. school year, fiscal year
etc.): ___________
____________________________________________________________
Are
you willing to make a commitment to report back to PFLAG at the end
of this time period on how our donation was used and the results of
your project? ___yes ___no
Name
of your contact person: _____________________________________________
Phone number:__________________________________________________
Name
of Faculty advisory: ________________________________________________
School Address:
________________________________________________
____________________________________________________________
Phone:
_______________________________________________________
Email: ________________________________________________________