Charitable Donation Request Form

Pump House Donation Policy

Thank you for thinking of the Pump House Regional Arts Center for your upcoming event. The Pump House supports fundraising events for nonprofit arts organizations through the donation of tickets or a class tuition, subject to availability and within our monthly donation limits. We do not issue monetary donations. Although we would like to grant all requests, we must limit the number of contributions we make. The applying organization must be a 501(c)(3) organization located within 50 miles of our address. The event for which the donation is requested must be arts related. Please note we do not make donations to specific individuals, families, religious or political organizations or any organization that represents an issue generally regarded as political. Donations are limited to fundraising events only. We do not donate prizes. All donations requests must be received a minimum of 4 weeks prior to the event.

Arts Discipline (visual, performing, literary arts)*

All events requesting donations must be arts related, so please how your event aligns within the arts.

Name of Organization*

501(c)(3) Nonprofit Tax ID Number*

Mission of Organization*

Location of Organization from La Crosse, WI*

0 - 25 miles
25 - 50 miles
Over 50 miles

Event Name*

Purpose of Event*

Event Date*

Event Description*

Please provide a brief description of the event including the date, the purpose of the event, and type of event.

Event Website

Contact Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Donation*

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Phone

This field is for validation purposes and should be left unchanged.