Diamond Impact Award

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Country *

Organization Type *

State/Province

Please fill out any missing organization information below.

Organization Name *

Tax ID If you know the Tax ID it will speed up the processing and verification of your request.

Zip/Postal Code *

Is there a different name, DBA or chapter?

Year Established

National Taxonomy of Exempt Entities (NTEE) Code *

Mission Statement *

Org Contact First Name *

Last Name *

Title with the Organization *

Organization Address *

City *

State/Province *

Primary Organization Email *

Primary Organization Phone *

Website *

Principal Individuals and Board Members *

The person completing this form who wishes to receive email updates should be entered here

Prefix *

First Name *

Last Name *

Email Address * (a verification email will be sent to the email above to ensure that you are able to receive emails for this request and also any future communication on the status of the request. Please click "Send Email Verification", if you did not receive the Verification email from DonationX.org. You might want to check your spam folder or try a different email address)

Email Verification Code *

Primary Phone *

Cell/Other Phone

Title/Relationship to Organization *

Attachment (optional): Add any additional files that may be helpful for this request

(Click on Upload File button to attach multiple documents. The files should be selected from a folder on your computer. The files will be listed under the attachment box. Files will be uploaded when you click submit. Attachments must be in one (1) of the following formats: Pdf, doc, docx, xls, xlsx. Limit the file size to less than 10MB.)

Comments

I confirm that I am 14 years or older

* Denotes required fields

This form will expire after 2 hours. You may save as draft after completing a few key details.

A DonationXchange account will be created and provided in the confirmation email for tracking purposes.

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Diamond Impact Award

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