Recipients — Expanding Villages

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Recipients

If you are a person in need or would like to refer a family or individual in need, please complete the referral form and hopefully we can make a connection. As we grow we hope to receive referrals from our Columbus community including nurses, social workers and other local agencies. All Columbus individuals served will live in the Columbus surrounding area and will have been deemed “in need” by the referring individual or agency.

Name *

First Name

Last Name

Email *

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is this a Temporary Address?

No

Yes

Number of Children (if applicable)

Enter Age, clothing/shoe size for each family member

Pets in the Household?

Any Known Allergies?

Specific Items Needed?

Are you able to pick up donations?

Yes

No

Distance you are willing to travel to pick up donations:

Five Miles

Ten Miles

Fifteen Miles

Frequency you prefer to receive donations?

Monthly

Quarterly

Please provide additional comments outlining recipient(s) situation or needs

Who referred you to Expanding Villages?

Self

Other: List above in comments

Expanding Villages will try to best match donors and recipients but will not monitor all communications regarding pick-up and drop-off details. This will be the responsibility of both parties until future pick-up and donation sites become available.

I acknowledge the program guidelines and agree

Expanding Villages will not be responsible for monitoring any goods or items received by recipients: ***Please note that all donations must be in good working order, readily useable without the need for repair, free of dirt, mold, water damage, pet hair, etc. Please do not try to donate any items that could be dangerous for recipients with children. Per Ohio Section 2305.37 a person donating perishable food or canned goods to needy individuals is not liable for harm; however, donors should take all precautions possible to donate only items in excellent condition that are not expired or recalled.

I acknowledge the program guidelines and agree

Thank you!

About Expanding Villages

Expanding Villages will connect people in need with resources that can enhance their quality of life.

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First Name

Last Name

Email Address

We respect your privacy.

Thank you!

***No goods or services will be received in exchange for donations to Expanding Villages recipients.

Donor and recipient participation is 100% voluntary and at the discretion of Expanding Villages.

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Support@Expandingvillages.org