Agency Form - Thankful-Giving - BarbaraCares - Breast Cancer Advocacy | Breast Cancer Support

The BarbaraCares Foundation welcomes agencies, other nonprofit organizations and groups to request items during this outreach effort. Once we receive and review your submission form, you will receive a phone call or email to verify your information and eligibility. Distributions days for Thankful-Giving will be Friday November 18th and Saturday November 19th in Fort Worth. Due to limited quantities available, all interested parties must complete this online form prior to distribution days. A check-in list will be available on-site during the distribution days to confirm names for the giveaway.

Details for Agencies and Organizations:
The BarbaraCares Foundation will be providing a Turkey along with all the sides to agencies/organizations that serve individuals and families affected by breast cancer. Please read carefully to complete the entire form. You may electronically submit the application or print the form and scan it for consideration to our email at: [email protected] or mail the completed form to:

BarbaraCares
P.O. BOX 15007
FORT WORTH, TX 76119

BarbaraCares has implemented the following criteria which must be met to establish eligibility for Thankful-Giving. If you answer Yes or meet the guidelines to all of the questions below, you qualify.

The criteria are as follows:

Agency / Organization must be operating in Texas and serving the DFW metroplex
Agency / Organization must be in good standing with IRS and state boards
Agency / Organization must provide supportive services in some capacity to cater to breast cancer patients and caregivers
Agency / Organizations may request multiple boxes based upon the need of their clients (due to limited quantities, all requests are subject to modification and not guaranteed until confirmed by BarbaraCares representatives)
Agency is responsible to pick up items and distribute to their clients. If the agency is not able to pick up items, please refer the individuals to our website to complete the form on their own and list the agency as the referral.
Requesting representative must be 18 years or older

agencies and organizations APPLY BELOW

* Indicates required field

Name of Agency / Organization *

First

Last

Email *

Official Role or Title *

Birthdate MM/DD/YYYY *

Phone Number *

Business Address *

Line 1

Line 2

City

State

Zip Code

Country

Please List Type(s) of Clients You Serve (Example: Cancer Patients, Resource Center for Elderly) *

Upload 501c3 Letter or Organization State Documentation *

Max file size: 20MB

Does Your Agency Assist Breast Cancer Patients and Caregivers? *

How Many Boxes Are You Requesting? *

How Many Boxes Will Go To Breast Cancer Patients /Caregivers? *

Are You Able To Pick Up Boxes On Distribution Day? *

I Am Filling Out The Application As: *

Authorized Representative of Agency / Organization

How Did You Hear About Us? *

Please select from the following? *

Requesting: Turkeys + Sides Requesting: Turkeys ONLY Requesting: Sides ONLY

Select Distribution Day *

Signature
Please read the following information carefully before signing and submitting: I hereby understand and recognize that the BarbaraCares Foundation Thankful-Giving Application is part of the BarbaraCares Foundation, a Texas nonprofit corporation which is a recognized tax exempt organization pursuant to Internal Revenue Code Section 501 (c)(3). Thankful-Giving has been solely and exclusively established for the benefit of those persons diagnosed with breast cancer and to assist the caretakers providing support for breast cancer patients here in the state of Texas. Meals provided are not based on marital status, race, gender, ethnicity, orientation or religion. However, meals given are granted to provide assistance to those individuals who have a demonstrated a need and live within the designated service area (Dallas - Fort Worth metroplex).

Accordingly, I have read and affirm all the information provided is truthful and accurate. I hereby certify that the information disclosed on this application is true and accurate. I further certify that this agency/organization serves populations that have been diagnosed with breast cancer and/or assist caretakers of patients currently receiving treatment. I understand that if any of the information set forth above is false, the application will be denied and if funding and/or resources have been released, the foundation will pursue any and all legal means available to retrieve any losses incurred.

By signing the signature/clicking the submit button below, I agree and give permission for the BarbaraCares Foundation to verify the provided information.

Submit

Thankful-giving SUBMISSION FORM!

agencies and organizations APPLY BELOW​

agencies and organizations APPLY BELOW