If your organization's needs could help further our mission, then we may be able to help. Complete the form below for consideration. Your fully completed request must be received at least one month before the board meeting closest to your event to be considered for a donation. A word of advice, if you are having problems getting values to submit, the most common reason is copying from publications and pasting into this form. When you do so you often are really also copying invisible formatting characters that will not validate.

Legal Name * Tax ID Number * Affiliated with a state or national organization? * --------- Yes No Classified 501(c)(3)? * --------- Yes No Geographic region served * Your services? * Where does the money raised go? * What percentage of each dollar raised directly supports client services? * What are your organization's mission and goals? *

Contact Information

Contact Name * Address * City * State * Zip/Postal Code * Phone * Fax * E-Mail * Website URL *

Information About This Request

Name of project or event * Location * Date * Time * What is the project's budget? * Amount requested from The Kinney Drugs Foundation, Inc.? * How will these donated funds be utilized? * What other funding sources does this project have? * If this request is to support Event Sponsorships, please describe how The Kinney Drugs Foundation, Inc., will be recognized at your event * Submit

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