Required fields are marked with asterisks (*)

Community Contribution Request Form

Please fill out the required information below for review by the Newmont Porcupine Community Investment Committee.  Failure to provide complete information will result in a delayed response.  Should funds be approved, your organization will be required to complete a Contribution Acknowledgement Form and Contribution Post Initiative Survey, where applicable.

All fields marked with an asterisk (*) are mandatory

Please select one of the following that best describes your Organization:
Please select the donation category that best aligns to your event/initiative:
Type of Request:
Have you approached other Organizations for support?
Will Newmont Porcupine's contribution be used to leverage funding?
How many people will benefit directly from this event/initiative?
Will the event/initiative enhance the development of local skills and/or business capacity?
Does the event/initiative aim to promote diversity and/or support underrepresented groups?
What beneficiary group(s) will be impacted from this event/initiative? You may select more than one.
Has Newmont Porcupine provided support to your organization in the past?
Will this event/initiative proceed without a contribution from Newmont Porcupine?
Would you like to submit a supporting image or file?

Key Contact Person

Recipient Name and Mailing Address

Is payment information same as above?