Organization Name

Organization Contact

Phone Number

Contact Email

Address

City

State

Zip Code

Website/Social Media page (optional)

Mission of Organization (100 words or less)

Is your organization a non-profit 501(c)3? YesNo If your answer is no, this form cannot be completed.

Is the request a sponsorship or donation? SponsorshipDonation

Description of Request (150 words or less)

Contribution Amount

Does the request meet one of the following? - Check all that apply: FoodClothingShelterMedical AssistanceSTEMDE&I Form W-9 (Request for Taxpayer Identification Number and Certification) will be required and must be sent timely to community@tdstelecom.com upon your request to complete the approval.