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Book Donation Request Form
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First Name
*
Your answer
Last Name
*
Your answer
Address
*
Your answer
Contact phone number
*
Your answer
Email Address
*
Your answer
Describe the level of economic distress your population experience.
*
High
Medium
Low
Percent of your population that lives on or below the poverty line.
*
Your answer
Describe the population you serve:
Enter a percentage number for each ethnic group in the next 6 questions (0%, 10%, etc)
Black/African American
Your answer
Hispanic/Latinx
Your answer
Asian American
Your answer
Native American
Your answer
White, Non-Hispanic
Your answer
Other racial/ethnic minority
Your answer
Are you a 501c3?
*
Yes
No
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