Modern Mouse Donation Request Form
Modern Mouse strives to make valuable contributions in support of community causes and efforts. We recognize that there are many causes worthy of support, but feel that our impact is made greater by focusing our limited resources in a few areas.

Please help us by filling out this form. Incomplete and physical forms will not be considered. We review donation submissions once per month, so please allow enough time, at least 1 month in advance, before requesting your donation. Thank you for your time in assisting us to make effective decisions toward the betterment of our community!

***Due to an influx of submissions, Donation Requests for Modern Mouse are currently closed for events taking place during August & September 2018.***

About You
Your name (first and last) *
Your answer
Your relationship to the organization *
(check all that apply)
Required
Your phone # *
(please include area codes and dial-out digits where applicable)
Your answer
Your email address *
Your answer
Your relationship with Modern Mouse *
(check all that apply)
Required
About the Organization
Name of organization *
Your answer
Is it a 501(c)3? *
Describe the organization's mission *
Your answer
Website address *
Your answer
Executive Director's name and contact info *
Your answer
Has this organization received a donation from Modern Mouse in the past? *
About the Event
Name of event and event type *
Your answer
Please describe this event's: Goals, Fundraising Target, and Progress Against the Target *
Your answer
What will the donation be used for? *
(check all that apply)
Required
What types of donations tend to perform the best at your type of event? *
We want to ensure that our donations make the biggest possible impact to the bottom line success of our donees' fundraising efforts. Please help us by thinking about the types of donations perform the best at your type of event, and how it should be packaged.
Your answer
Considering the above, what type of donation are you seeking from us? *
Required
Event Date *
MM
/
DD
/
YYYY
Date donation needed by *
MM
/
DD
/
YYYY
What type of recognition does the event have planned for donors? *
(check all that apply)
Required
Name and contact info for person who will pick up the donation *
(list previous donations if applicable)
Your answer
Previous donations that Modern Mouse has made to you and/or to this organization
Your answer
Any other comments?
Your answer
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