Organization Name

Address                                            City                    State                     Zip Code

Contact Person/Title             Phone number (we will contact you)                Email address

Type of donation you would like to make:

        (  ) Food                            (  ) Clothing                                (  ) Volunteers

        (  )Toys                             (  )  Funds                                  (  )  Boxes/Bags

        (  )Transportation     (  )  Other (Please list):____________________________________

(  ) We would like to Adopt-A-Family in the ___________________________area.

(  )We would like to donate _______ gift cards in the amount of ____________ for

                                           Total No.                                                                             $amount each   

          the age group(s) noted below.

(   ) Ages 0-2                                        (   )  Ages 3-5                         (   ) Ages 6-9     

(   ) Ages 10-12                                    (   )  Ages 13-16                      (   ) Ages 16-18

(  )  We would like to donate gift cards in the amount of $__________ each to be

 used to purchase a ham/turkey for the holiday meal.

(  ) We prefer to donate funds directly to CiACC so they can purchase the items

 they need to complete their holiday food and toy boxes.

CiACC is a 100% volunteer run organization, none of the funds received go

to support administrative costs, so 100% of your donation reaches those in need.

 You may donate directly by this application through the US Mail, Paypal (contact us)

 or through the United Way of the Columbia-Willamette.  Our United Way Number

is “TOY7103”.  Be sure to click other at the bottom where it asks how
you found  out about The United Way, then designate us as
your charity of choice in the drop down box!!!

 http://www.unitedway-pdx.org/donations/default.aspx?localCode=39180

PO Box 197
Oregon City, OR  97045