This form is to be completed by the referring agency/organization, business, or individual for qualifying charitable organizations in need of domestic transportation services. Referrals will be considered and interviewed before confirmation of acceptance. The referred organization must be involved in the business of helping needy families by providing food, clothing or medical supplies at low or no cost, and preferably provide employment and vocational or educational opportunities.

Charitable Organization

When referring an organization or individual for domestic donated transportation services please make certain that you possess pertinent information about their organization before making the referral.

1. Information

2. Why are you referring this organization for transportation services?

3. How long have you known about this organization?

4. Have you worked in the capacity of volunteer, case worker, counselor,
caregiver, or pastor for the organization being referred?

5. Explain what the organization is doing to help improve the lives
of people in need, and state future goals/plans they may have.