Nonprofit Partnership Disclosure Consent Form
Please provide your nonprofit organization details, the partnership disclosure information, and consent from an authorized representative to share the specified partnership details.
Organization & Contact Information
Nonprofit Organization Name
*
Primary Contact Name
*
Contact Email
*
example@example.com
Partnership Disclosure Details
Partner Organization Name
*
Partnership Type or Relationship Description
*
Description of Partnership Details to Be Disclosed or Shared
*
Consent & Authorization
Consent Acknowledgment
*
I authorize the nonprofit to disclose the partnership details described above to the intended audience or purpose.
Signature of Authorized Representative
*
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: