Evidence Action Donation Form

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Thank you for choosing Evidence Action for your contribution. Completing this form enables us to efficiently designate and acknowledge your donation.

Full Name *

Email *

Donation Amount *

Would you like to restrict your giving? *

No, I choose not to restrict my giving so that my contribution goes to Evidence Action (Unrestricted)

Yes, I would like to restrict my donation to Safe Water

Yes, I would like to restrict my donation to Deworm the World Initiative

Yes, I would like to restrict my donation to Accelerator

Yes, I would like to restrict my donation to Iron and Folic Acid Supplementation

Yes, I would like to restrict my donation to Maternal Syphilis Screening and Treatment

If you would like to remain anonymous, please check this box.

Yes

If you would like to dedicate your donation in honor or in memory of someone, please provide their name below. If you provide their email, we will notify that person.

Mailing Address

Phone Number

Organization Name (for donations made on behalf of an organization or corporation)

Organization Email (for donations made on behalf of an organization or corporation)

Is this a corporate match?

Yes

If this gift will be matched by your employer, please provide the name of your employer.

How did you hear about us?

If you heard about us from GiveWell, may we share your information with GiveWell? (If left blank, your information will NOT be shared.)

Yes

Thank you for your support!

Should you require any assistance or have questions, please contact us at donate@evidenceaction.org

Please make your donation payable to Evidence Action. If you are donating via check, please mail your check to the following address:

PO Box 65480
Washington, D.C. 20035
United States

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