Donation Request Form Donation Request Form Organization and Contact Information Name of Organization * Organizational Address * Organizational Address Organizational Address Organizational Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Organization Type * Donation Contact Person * Donation Contact Person First First Last Last Title/Position * Email Address * Phone Number * Event Details Event Title or Description * Date of the Event * Purpose of Event * Estimated Attendance * When was the (approximate) last time you received a donation from the Connecticut Science Center? Any additional information that you think would be helpful to us. 0 of 300 max words Proof of Non-Profit 501(c)(3), School, or Municipality Status File Upload * Drop a file here or click to upload Maximum file size: 134.22MB You must provide proof of your non-profit 501(c)(3), school, or municipality status. Submissions without proper documentation will not be considered and will not receive a reply. Submit Start Over If you are human, leave this field blank.
