Mask Donation Request

2. Masks are available in large quantities of 500+ to faith communities, nursing homes, non-profit organizations, etc. A request form must be completed and approved before a pick-up time is arranged.

   Masks are available in large quantities of 500+ to faith communities, nursing homes, non-profit organizations, etc. A request form must be completed and approved before a pick-up time is arranged.

4. Requesting Organization*

6. Contact Person*

7. Title*

9. Contact Email*

11. Address*

12. Zip Code*

14. Type of organization*
    -- Select One --Church, Synagogue, Mosque, TempleEducational FacilityNon-Profit OrganizationSenior Care FacilityPublic Safety PersonnelOther (please explain)

    Please note: For-profit businesses cannot apply for donations per guidelines of donor

15. Please explain if you selected 'other'

17. Requested Amount*
    -- Select One --5001000150020002500

18. Please justify your requested amount*

20. *Requests may take up to 7 days to approve. If approved, the requestor is responsible for picking up the masks at pre-approved time by the City of Aurora

    *Requests may take up to 7 days to approve. If approved, the requestor is responsible for picking up the masks at pre-approved time by the City of Aurora

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field