Donation Requests

In order to better understand the needs in our communities and how your organization serves them, we ask that this questionnaire be completed and returned.

Date: / /

Organization Information

Name:

Organization Phone:

Organization Fax:

Mailing Address

Street:

City:

State:

Zip Code:

Physical Address (if different than mailing address)

Street:

City:

State:

Zip Code:

Website Address:

Contact Person

Name:

Title:

Phone:

Fax:

Email:

Organization's Services

Mission Statement:

Check any of the following that pertain to the services your organization provides. Affordable Housing Community Services Economic Development Revitalization or Stabilization of Designated Areas Neighborhood Stabilization Program (NSP)

Briefly describe the services your organization offers:

Does your organization offer financial literacy classes? Yes No

Does your organization offer any type of homeownership classes, foreclosure prevention classes, or credit reporting informational classes? Yes No

Please check all of the counties your organization serves.

Beneficiaries of Organization's Services

Briefly describe the individuals benefiting from your organization’s services.

Can anyone receive the benefits of your organization? Yes No

Of the individuals benefiting from your organization’s services, are any considered to have a low-to-moderate income? Yes No

Organization's Needs

Does your organization currently have any financial needs (grants, mortgage, software, etc.)? If so, please briefly describe.
Does your organization participate in any annual events that serve low-to-moderate income individuals? If so, please briefly describe.
If there is any additional information not previously mentioned in this questionnaire that you would like to share about your organization, please describe below or attach any additional documentation with your response.

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Thank you for helping CommunityBank of Texas give back!

Donation Requests

Organization Information

Organization's Services

Beneficiaries of Organization's Services

Organization's Needs

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