Request Form for Contributions

	Name of charitable organization
	Date
	Address
	City
	State
	ZIP code
	Telephone number
	Contact person
	Title
	E-mail address
	What is being requested?		Cash	Surplus items	In-kind services
	What is being requested?		Other	Volunteers...
				Approximately how many?

	Please explain
	Requested amount	$
	Date needed
	If approved, check should be made payable to...
	How would this contribution be used?
	Date of event
	If volunteers, what type of work is to be done?
	Number of volunteer hours?
	What recognition will TVA receive through its participation?
	Is the organization a United Way agency?		Yes	No
	Is the organization a not-for-profit 501(c)(3)?		Yes	No
	What is the specific purpose of the requesting organization?
	How does this fit into TVA’s Corporate Contributions Guidelines?
	Is this organization receiving any other support from TVA?
	Names of TVA employees serving on the board of the requesting organization
	What other organizations are sponsors in this endeavor?

Fill out the following information only if you are a TVA employee.
	Name of TVA contact:
	TVA phone number:
	TVA address: