Supply Drive box Requests

Name of Organization *

Affiliation*

Student Organization

LSU Department/ Office

Community Organization

Contact Person (This person will be responsible for checking and removing the box)*

Phone Number*

Email Address*

Start Date *

End Date*

What type of supplies will your orgnaization be collecting? *

I authorize that all information provided on this application, including any and all data may be shared with the Women's Center staff to fulfill supply drive requests. This data will be retained for one year.

* Your organization will be responsible for checking and removing the box by the stated end date. The Women's Center is not responisble for the items donated. We reserve the right to decline requests upon review. The Women's Center will only accept two drives to happen at the center at one time. Requests are on first-come frist-serve basis.

To learn more about privacy at LSU, please see the LSU Privacy Statement.

Please Check*

I authorize

I agree

Request for Supply Drive Box