Scholastic Book Grants In Kind Donation Application Page 3
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3SCHOLASTIC BOOK GRANTS
IN-KIND DONATION RECIPIENT FORM
Date:
_________________
Organization Name:
_________________________________________________________________________
Mailing Address:
_________________________________________________________________________________
(street)
(city)
(state)
(zip code)
Telephone:
(
)__________________________________________________________________________
Fax:
_________________________________________________________________________________
E-mail:
_________________________________________________________________________________
Name/Title of Person Completing This Form:
_________________________________________________________
Type of Donation:
"Book Donation"
Condition of Donation (check one):
Excellent
Good
Fair
Poor
Date Donation Received:
_________________________
Please verify that books were not resold or used for fundraising purposes with printing and signing your first and last name.
Print Name
_______________________________
__________________________________________
(Sign name)
IRS Tax-Exempt Status (exempt/nonexempt) Reference Number:
__________________________________
Please fax or mail back form to:
Scholastic Book Grants: Community Affairs
557 Broadway 2
Floor
th
New York, NY 10012-3999
212/343-4912 (fax)
Official Use - Please do not write below this line.
Estimated Value of Donation: $______________________
Number of Books Donated: ___________
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