Corporate Giving Program - Donation Request Form
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Donation Request Form:
Organization name
Address
City
State
Alabama
Alaska
ALBERTA - CANADA
American Somoa
Arizona
Arkansas
BRITISH COLUMBIA - CANADA
California
Canal Zone
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
MANITOBA - CANADA
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
NEW BRUNSWICK - CANADA
New Hampshire
New Jersey
New Mexico
New York
NEWFOUNDLAND - CANADA
North Carolina
North Dakota
North Marianas
NORTHWEST TERRITORIES - CANADA
NOVA SCOTIA - CANADA
Ohio
Oklahoma
ONTARIO - CANADA
Oregon
Pennsylvania
PRINCE EDWARD ISLAND - CANADA
Puerto Rico
QUEBEC - CANADA
Rhode Island
SASKATCHEWAN - CANADA
South Carolina
South Dakota
Tennessee
Texas
Trust Territory
U.S. Virgin Islands
Utah
Vermont
Virginia
Washington State
West Virginia
Wisconsin
Wyoming
YUKON - CANADA
Zip Code
Brief Description
501c(3) Determination Letter
Tax Identification Number
Contact Person
Title
Phone Number
Email Address
Describe the purpose of the request
Project Location
Estimated Date/Need for Delivery of Product
Amount Requested (take-offs required)
Describe the expected results and total goal for the program or projects.
James Hardie has three giving categories, which best describes your organization or project?
Shelter
Solutions
Community
What is your cash request total?
What populations does your organization serve?
General
Aging
Low income
Children
Multi-Cultural
Disabilities
Women
What geography does your organization serve?
Local
National
Both
Do any James Hardie employees currently volunteer with your organization?
Yes
No
Have you ever applied to James Hardie in the past?
Yes
No
What other organizations have you approached for support?
For Requests $5,000 and Above -
If you are requesting $5,000 or more in cash, sponsorship support or product donations, please provide the following information:
Program or project timetable:
Evaluation criteria you will use to measure success
Summary of current and/or past financial and volunteer support from James Hardie
Operating budget for organization's current fiscal year
Current project/program budget
Annual Report including the following information:
List of major donors for the most recent and current fiscal year
List of board of directors and affiliations
Audited financial statement
Mission, goals, objectives (2-3 sentences)
Current programs and activities
Geographic area and general description of population served
Number of people served per year by entire organization
Please provide any additional information that will be helpful to us in considering your request.