Milwaukee County 4-H Chartered Clubs/Groups Donation Form
Name of 4-H Chartered Club or Group: __________________________________
9501 West Watertown Plank Road, Building A, Wauwatosa, Wisconsin 53226
Phone of 4-H Treasurer: __________________________________________________________
Email of 4-H Treasurer:___________________________________________________________
http://milwaukeecounty4-h.org
Donation submitted by:
Date Submitted:
Donation made by: (name)
(address)
(email address)
(phone number)
Value of the donation: $
Type of donation made: (Please check one)
__ Monetary
__ In-Kind Service
Explain the intent of the donation:
__ Items,
List items donated:
Note: Submit a new form for each donation.
For Club/Group’s Treasurer and General Leader Use Only:
Date Received: _________________
Was the donation accepted or denied? __ Accepted or __ Denied
Reason for denial?___________________________________________________________________
Was a confirmation letter sent by club/group representative? ___ Yes or ___ No
Sent By ______________________________ When ___________________________________
Date donation received: ________________________ Check No. _________________________
An EEO/AA employer, University of Wisconsin-Extension provides equal opportunities in employment
and programming, including Title IX and American with Disabilities (ADA) requirements. © 2014 by the
Board of Regents of the University of Wisconsin System Developed by the Wisconsin 4-H Office, 436
Lowell Hall, 610 Langdon St., Madison, WI 53703. The 4-H name and emblem are federally protected
under Title 18 US Code 707.