Donation Request Form

* This field is required

Organization Profile

*Name of organization

*Charitable registration number (as provided by the Canada Revenue Agency)

*What is the primary focus of your organization?:

*What is the geographic scope of your organization?:

If 'local or community', please tell us where.

*Please give a brief history of your organization.

*Please list your organization's goals and achievements.

*Please give a description of the clients or groups served.

*Did an OTIP employee refer you to this application?

YesNo

If yes, please provide details.

Contact Information

Primary Contact Person

*First and last name

*Position in organization

*Telephone number and extension

*Email

Organization website address

Address of Organization

* Address:

*City

*Province

Request Details

For reference purposes, please provide a name for this project, program or campaign.

*Please describe your project, program or campaign for which you are requesting funding.

*What is the geographic scope of this project, program or campaign?

What is the total budget?

Money raised to date

*What amount are you requesting from OTIP?

*What are the predicted outcomes of this project, program or campaign, and how will you measure whether you have been successful in achieving those outcomes?

*How do you plan to recognize our involvement and support?

*Has your organization received funding from OTIP in the past?

YesNo

*If yes, please provide details.