Charitable Donations Request Form

Contact Information

* Contact Name

* Phone
xxx-xxx-xxxx

* Email

Organization Information

* Organization

* Address

* City

* Website

* Registered Charity Number

Request Information

* Organization's mission, vision, or values statement

* Briefly describe the services you provide in the community

* What age groups do you serve?

* How many clients / residents are served annually by your programs / organization?
residents served per year

* Amount requested

* How will the funds received make a positive impact on the community?

* Most recent annual report
Files can be no larger than 5 MB, pdf, doc(x), xls(x) or txt files only

Past Donations

* Have you received a donation from the Chair's Charity Golf Tournament in the past? Yes
No

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email our Access and Privacy Office or call 905-980-6000 ext. 3779.