Charitable Request Information Form | Genesee Regional Bank | Rochester, NY - Commercial Banking, Personal Banking, Mortgages

Please tell us a little more about your organization and what you do for the community.

Organization*

What is the mission of the organization?*

Name*

Phone*

Email*

Your Relationship to the Organization*

Organization Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Organization Phone*

Organization Leadership and Board Members*

Who is served by the organization? (click all that apply).*

Please provide any additional information about the population served by the organization (optional).

What services are provided by the organization? (click on all that apply).

Basic services (food, clothing, shelter)
Life skills (maximizing potential, education, job training, etc.)
Health services (research, care, counseling)
Community enrichment (arts, music, theater)

Other services provided by the organization not covered above (optional).

Percentage of Low-to-moderate Income people served by the organization

Do you have volunteer opportunities available with your organization? If so, please describe them below. If you provide volunteer opportunities online, include the website link.

Upload the Organization's W9

Max. file size: 1 GB.

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Phone

This field is for validation purposes and should be left unchanged.