_______FINANCIAL DONATIONS______

Thank you so very much for supporting our mission to empower and change the trajectory of black and brown girls in our community! Your contribution means the world to us!

Please share your reason for giving on the form below and with your networks—use our promo toolkit (www.ImaraRoose.org/promo).

For more information, visit www.ImaraRoose.org or email Contact.ImaraRoose@gmail.com with “Donate” in the subject line.

Sign in to Google to save your progress. Learn more
FIRST NAME *
LAST NAME *
CONTACT INFO
EMAIL ADDRESS *
GMAIL PREFERRED
HOME ADDRESS
We hope to soon be able to share a token of our appreciation, we’ll send it via mail.
INSTAGRAM HANDLE
CELL PHONE
xxx-xxx-xxxx
DONATION
DONATION DATE *
Please specify the date of your donation:
MM
/
DD
/
YYYY
DONATION AMOUNT *
Please specify the amount of your donation:
DONATION METHOD *
Please specify your method of donating:
DONATION RECEIPT *
Would you like a tax-deductible receipt as proof of your donation?
REASON FOR GIVING *
Please briefly describe your reason for giving to Imara Roose:
PERMISSION TO SHARE *
Do we have your permission to share your name and reason for giving (i.e., via our social media, website, newsletter, blog, etc.)?
OTHER
HOW’D YOU HEAR ABOUT IMARA ROOSE? *
If you selected an option that indicates "specify" please detail your answer below:
GET INVOLVED
Are you interested in getting involved with Imara Roose? Visit www.ImaraRoose.org/getinvolved to learn more. Please indicate your preferences below:
If you selected other, please detail your answer below:
ADDITIONAL INFO
Is there any additional information you’d like to share?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms