Organization / Contact Name

Phone

Preferred Drop-off Time

Donation Location

Ready Date

Donation Category (select all that apply)

Medical and Health Supplies Water, Sanitation and Hygiene Shelter and Bedding Non-Perishable Food Debris Clearance & Tools Building & Repair Materials

Item Description

Quantity / Pallet Count / Weight (approx.)

Packaging Status

Notes (optional)

I confirm items are safe, new/unused where applicable, and non-expired (for medical).

I agree to the compliance statement above. I agree to NCI Foundation’s data policy.