In-Kind Contribution Form

Thank you for your generous in-kind donation to Health Connected! With your support, we can positively impact and empower our community's young people with essential sexual health education.

Name *

First

Last

Organization Name

If applicable

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Contact

Email *

Phone *

Please provide a description of the item(s) you are donating. *

Item # & Value

How many items are you donating? *

What is the total estimated value? *

Please estimate using fair market value standards.

Signature

Signature *

Date *

Health Connected is a 501(c)(3) non-profit organization (EIN/Tax ID: 94-3227947). An in-kind donation is defined by the IRS as a non-cash gift of goods or services that has a fair market value. By submitting this form, you confirm that you are the rightful owner or have the necessary authorization to donate the goods or services to Health Connected. Your contribution is tax-deductible to the fullest extent allowed by law. Please consult a tax advisor to verify the deductibility of your donation. In accordance with IRS Publication 561, Health Connected reserves the right to evaluate and adjust the fair market value of donated goods or services if it believes the value provided is inflated or inconsistent with industry standards.