Request A Donation

We are happy to consider your donation request. In an effort to review each donation request, please complete the Donation Request Form. We review these requests monthly, so we ask that you submit your request at least two months in advance before the needed date.

Request A Donation

Organization *

501c(3) number *

Name *

Phone *

Email *

Donation Request Amount *

Donation Needed By

Describe your organization & how it serves the local community *

How did you hear about ICCU?

How will donations be used, if approved? *

Consent *

I agree to provide consent for Intricon to collect my personal data.

In order to comply with 2202 GDPR requirements, Intricon requires consent to collect the information provided in this form. For more information on how we handle your personal data, please read our Privacy Policy.