Fund-raising for a charitable, educational (8th grade or below only), or a non-for-profit organization. Proceeds or actual item may NOT be provided to a high school, preparatory school or 2-year college for any reason. ALL proceeds from the resale or auction of this item must go directly to the charitable, educational (8th grade or below only), or non-for-profit organization.
A certificate to redeem four tickets to a regular season varsity sports event of your choice will be used to fulfill all approved requests. Completion of this form does not guarantee that the Dartmouth College Department of Varsity Sports will fulfill the request.

Required Fields are in Bold

	Name of Requester:

	Email of Requester:

	Phone Number of Requester:

	Name of organization requesting this donation, or name of organization the requester is affiliated with.

	This Organization is:
	Dartmouth College (or recognized entity therof - e.g., Student Gov., Greek, etc.). The Ivy League Conference Educational Charitable Non-Profit None of the above

	Delivery Address of Donation (street, city, state, zip):

	Location of the event/activity where this donation will be used:

	Date of the event/activity in which the donation will be used:

	Specific request(s) related to the donation (not guaranteed to be satisfied):

	How will the donation requested be used (i.e. raffle, auction, etc.)?

	If money is being raised, what will the money go toward? Please be specific and detail who benefits from these funds raised.