Donation Request Form

Before You Apply

Must hold current IRS 501(c)(3) status
Must serve Taney County or Stone County, Missouri
Must be a public fundraiser (auction, raffle, etc.)
Event must be at least 45 days away
Must not have submitted a request in the last 12 months
If criteria are not met, application will not be reviewed

SECTION 1 - Organization Information

Legal Organization Name

Organization Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Primary Contact Name

Contact Phone Number

Contact Email Address

Organization Website

IRS Tax ID/EIN Number

SECTION 2 - Community Served

Which Missouri county does your organization serve?

Taney County, Missouri

Stone County, Missouri

SECTION 3 - Event Details

Name of Fundraising Event

Event Date

Event Location / Venue

Estimated Number of Attendees

If Other, please describe

Please describe in detail how our donation will be used and how it will benefit your cause

SECTION 4 - Donation Request

What type of donation are you requesting?

Complimentary attraction/park admission tickets

Show tickets

Merchandise package

Other

If Other, please describe

Number of tickets or items requested

SECTION 5 - Required Attachments

Incomplete applications will not be reviewed.

IRS 501(c)(3) Determination Letter (or current tax-exempt certificate)

Choose File

Official request letter on organization letterhead

Choose File

Brief description of your organization and its mission (1 page max)

Choose File

SECTION 6 - Certification & Signature

Certification Agreement Checkbox

I certify that all information provided is accurate and complete, our organization holds 501(c)(3) status, and we agree to the terms listed above.

Authorized Signature (Typed Name)

Printed Name

Title

Date Signed

Any Additional Notes

Shepherd of the Hills Community Donation Request Application

Before You Apply

SECTION 1 - Organization Information

SECTION 2 - Community Served

SECTION 3 - Event Details

SECTION 4 - Donation Request

SECTION 5 - Required Attachments

SECTION 6 - Certification & Signature