Community Request Form

  • Request Date

    OKRequest Date is required
  • Date for response from Atlantic (please allow 30 Business Days)

    OKDate for response from Atlantic (please allow 30 Business Days) is required
  • OKRequesters First Name is required
  • OKRequesters Last Name is required
  • OKEmail is required
  • OKPhone is required
  • Requestor’s affiliation with Atlantic

    OKRequestor’s affiliation with Atlantic is required
  • OKOther is required
  • OKOrganization’s Name is required
  • OKOrganization’s Phone is required
  • OKOrganization’s Street Address is required
  • OKOrganization’s City is required
  • OKOrganization’s State is required
  • OKOrganization’s Zip is required
  • OKWhat Community does this organization serve? is required
  • What type of organization is it?

    OKWhat type of organization is it? is required
  • OKOther is required
  • Do you have any Atlantic employees on your board or volunteer staff?

    OKDo you have any Atlantic employees on your board or volunteer staff? is required
  • OKIf yes, please list their name(s) is required
  • Type of Request

    OKType of Request is required
  • OKOther is required
  • OKWhat amount of funding is being requested? is required
  • OKFor what purpose(s) would the donation be used? is required
  • Has Atlantic contributed to this organization in the past?

    OKHas Atlantic contributed to this organization in the past? is required
  • OK is required