eGreen4Need Donation Request Form

eGreen4Need donates computer equipment to schools in need with educational programs that positively impact students lives. Our goal is to enrich students academic and extracurricular experiences by facilitating increased access to technology in their community. To determine the eligibility of your project/program for eG4Ns donations, please fill out this form. Send the completed form to whseg4n@gmail.com. Thank you for your interest in eG4N, and good luck! Demographical Information What project/program will the donations requested be used for?

What is the geographical area served by your project?

How many students will directly benefit from the donations in the year in which you are requesting the donation? (number of people) ________

How many of these students qualify for free/reduced lunches in the same year? (number of people) _______

List the number of students by gender in the same year: Male _______ Female _______

Project/Program Information 1. What type of computer equipment are you requesting, and how many? (ex: laptops, towers, mice, keyboards, monitors, speakers, etc)

2. Briefly describe the goals of this program/project (100 word max):

3. How will these donations benefit the students in your program/project? How will the donations be used? (300 word max)

4. How will you measure the impact of these donations on students in your program/project? (300 word max)

5. What makes your program/project unique? (100 word max)

Financial Information
Please include a spreadsheet with your project/programs budget in the year in which you are requesting the donation. You may include a separate narrative for your budget to elaborate upon details within your budget as well.

Administrative Contact Information

Name of Program/Project Primary Contact: Email: Phone Number:

Name of Adult Program/Project Supervisor: Occupation: Company: Email: Phone Number:

Name of School Principal: Email: Phone Number:

By signing this form, I approve this documents contents and confirm that all information inputted is accurate. I understand that false statements will delay the processing of this form and may cause this application to be nullified.

________________________________ Primary Contacts Signature

______________ Date

________________________________ Adult Program/Project Supervisors Signature

______________ Date

________________________________ School Principals Signature

______________ Date