Sponsorship / Donation

Request Form

Date Form Submitted:*

MM/DD/YYYY

First Name:*

Last Name:*

Email Address:*

Phone:

Organization Name:

Mailing Address 1:

Mailing Address 2:

City:

State:

Zip Code:

Website of Organization:

Mission of Organization:

Is your organization part of a STEM program?

Yes

Please explain what you are part of below…

What type of request will this be?

Donation

Sponsorship

In kind donation of parts

Reason for Donation:

Request:

How will the funds/parts be used?

Sponsorship Request:

Level:

Do you have other sponsors?

Yes

If yes, please send an email to donation.requests@mouser.com and attach sponsorship packet

or list other sponsors below…

How will Mouser Electronics be recognized (Mouser logo on website or poster)?

When submitting, please send an email to donation.requests@mouser.com and attach your W-9 form.

Do you have 501 C3 Status?

Yes

If yes, please provide number:

Other Comments: