donations

School or Organization's Name *

Contact Person *

First

Last

Contact Person's Email *

Contact Person's Phone Number *

Date / Time of Event *

Date

Time

Event Location Address *

Address Line 1

Address Line 2

City

State

Zip Code

What are you requesting from Chick-fil-A Lake Dow? Please be as specific as possible. *

Note: If you are not specific on the quantity and items that you are requesting, your donation request will not be considered.

Please describe your event in as much detail as possible. *

Does your organization have community-wide impact (such as military support, community outreach, etc)? Tell us how. *

Is this event impacting the community within 5 miles of Chick-fil-A Lake Dow? *

Yes
No

Will you be partnering with any other Chick-fil-A locations for this event, or is your organization a community partner with any other location? *

Yes
No

If yes, please list the other Chick-fil-A location(s).

Will the event be family-friendly and free of alcohol, tobacco and drugs? *

Yes
No

Will there be any third-party vendors promoting alcohol, tobacco or drugs? *

Yes
No

If yes, please describe their involvement.

Is this event for a specific individual that needs assistance due to injury, illness or hardship? *

Yes
No

If yes, please explain.

Has your organization placed a catering order with Chick-fil-A Lake Dow within the past six months? *

Yes
No

If yes, please list your receipt number (if available), date of purchase, and description of food items ordered.

Will Chick-fil-A Lake Dow's donation qualify them to be recognized as a community partner with your organization? *

Yes
No

If yes, please describe how this will be accomplished.

Do you understand that we will require a photo proof that recognition, as described has been accomplished before donation is allowed? Example: Photo of printed 4x8 banner with Chick-fil-A's approved image. *

Yes, I understand
Yes, I understand; however, I won't be able to supply proof prior to my event.
As mentioned above, Chick-fil-A Lake Dow will not be recognized for their donation at the event.

Did you complete this form at least 30 days prior to your event date? *

Yes
No

Do you understand that by submitting your request less than 30 days prior to your event, your request may not be considered? *

Yes
No

Do you understand that we will contact you if your donation request is approved? *

Yes
No

Is there any other information or details that you would like to share?

Donation Request Form