In Kind Donation Form - Dignity Housing
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1Breaking the Cycle of Homelessness
Providing Affordable Housing • Promoting Self-Sufficiency • Creating Opportunities
Beverly Roberts-Cruse, Executive Director
DIGNITY HOUSING IN-KIND DONATION
Thank you very much for making an in-kind donation to Dignity Housing. This form will help us to
properly record and acknowledge your generous gift. If you have any questions, please contact
Noelle Pitts at 215-713-0960 x208 or
.
Donor Information
Individual Donor or Company Name
Donation Date
Name of Person to be Thanked
Organization (if applicable)
Home/Cell Phone
Work Phone
Email
Mailing Address
City, State Zip
Item Description
To be filled in by donor at time of gift
Description of Item (include quantities)
:
Estimated Fair Market Value
Fair Market Value of Any Good or Services
To be filled in by donor at time of gift
Given to Donor in Return and Description of
Good/Service (for example: ticket to Dignity
The Salvation Army & Goodwill offer Donation Value Guides to
help determine the approximate tax-deductible value of some of the
fundraiser, t-shirt, etc.)
more commonly donated items
To be filled in by Dignity Housing
content/uploads/2010/12/Donation_Valuation_Guide.pdf
For Internal Use
Program designation:
Alicia’s House (DII)
Dignity III-BOSS
Enhanced Services Program (ESP)
All Programs
Dignity Resource & Opportunity Center
Dignity’s KEYSPOT Computer Lab
Other - please specify: _______________________
Date Submitted to
Initials of
Date Received by
Initials of
Fund Development
submitter
Fund Development
receiver
Dignity staff:
Please make a copy of this form for donor and attach any additional information to submission to Fund
Development (for example, contract or photocopy or picture of item if appropriate)
5227-R Germantown Ave. • Philadelphia, PA 19144 • (P): 215-713-0960 • (F): 215-713-0968 •
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