Mask Request Application for Schools
Thank you for your interest in the BStrong back to school initiative with Global Empowerment Mission to provide PPE in Schools. We look forward to helping maintain safety at our nation’s school this fall. If your school is in need of a PPE donation, please complete the following questionnaire and note that this application should only be used for individual schools. This application cannot be used to apply for PPE donations for an entire school district. If you are a representative for a school district please send an email to:
donations@globalempowermentmission.org
Or call (800)995-7604 ext. 2.
All questions on this application must be completed and an accurate mailing address and contact phone number must be provided. Please allow five business days for your application to be reviewed and you may be contacted by a member of the BStrong/Global Empowerment Team to review for school’s application and PPE needs.
If you have additional questions please email: Donations@GlobalEmpowermentMission.org
Or call (800)995-7604 ext. 2.
* Required
Email address
*
Your email
What State is your school or educational facility in?
Choose
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming
What County is educational facility in?
*
Your answer
Full name of your school or educational facility?
Your answer
Type of educational facility?
*
Choose
High School
Middle School
Elementary School
Charter School
College/University
Montessori School
Military School
Magnet School
Special Education School
Religious School
After School Program
Day Care
OTHER
Your full name and position at the educational facility?
*
Your answer
Direct Cell Phone # (Must be able to reach you to approve application)
*
Your answer
Full mailing address of educational facility? (Must include city, state, & zip code)
*
Your answer
Is this a private or public educational facility?
*
Choose
Public Facility
Private Facility
How many faculty members do you have on staff?
*
Your answer
How many students do you currently have attending classes onsite daily?
*
Your answer
P.P.E. needs at your location?
Your answer
Do you currently have masks at your educational facility?
*
YES
NO
Is there any other pertinent information you need to provide about this request?
Your answer
STATEMENT OF AGREEMENT *The disclosure of information on this form is voluntary; however, missing information may prevent assistance. Application submission does not guarantee approval. A committee will review and make decisions based on the organizations current funding and the urgency of each situation. By agreeing below, you solemnly swear that the information contained herein is reported in true faith. I UNDERSTAND AND AGREE TO THE TERMS & CONDITIONS STATED ABOVE.
*
YES
Required
Send me a copy of my responses.
Submit
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