PTF Program Partner Application

Pirate Toy Fund Program Partner Application Form

The Pirate Toy Fund distributes new toys to children in need throughout the Greater Rochester region year-round through our Program Partners. Our Program Partners support children affected by medically traumatic issues, domestic abuse, natural disaster, and the financially disadvantaged.

For your application to be considered, all fields must be filled out to the fullest.

Fields with * are required.

Organization Information

Tell us more about your organization.

Organization name (legal name) *

If known by another name or acronym, please indicate

Name of parent organization, if applicable (i.e., scout troop or school district)

Organization Address:

City:

State:

ZIP Code:

Organization's Main Phone #:

What is the URL of your organization's website?

Is your organization an IRS non-profit or public tax-exempt organization (e.g., schools, churches) as defined under Section 501(c)? *

Yes

What is your federal taxpayer ID number? *

Year organization founded?

What is your organization's mission? *

What county or counties does your organization serve? *

Executive Director's First Name *

Executive Director's Last Name *

Executive Director's Phone # *

Executive Director's Email Address *

Primary Contact

Your organization's Primary Contact will be the sole liaison between your organization and the Pirate Toy Fund regarding your requests for toys. If this person changes, you'll need to contact the Pirate Toy Fund's Program Coordinator in order for your program to continue receiving toys.

Primary Contact's First Name *

Primary Contact's Last Name *

Primary Contact's Phone # *

Primary Contact's Email Address? *

Toy Needs

Tell us how will you use our toys.

How did you hear about the Pirate Toy Fund?

Is your organization receiving toys from any other source (e.g., another organization, a toy drive, individual donations, etc.)? *

Yes

Has your organization been a Pirate Toy Fund Program Partner in the past? *

Yes

When does your organization plan to distribute toys received from the Pirate Toy Fund? *

Year-Round

Holiday season (Nov-Dec)

Summer camp/retreat or similar

Other (Please describe)

If you selected "Other" please describe.

Will ALL of the toys you receive from the Pirate Toy Fund be distributed during a specific event? (e.g., a holiday party, an awards ceremony, camp, etc.) *

Yes

If you answered yes, what is the required date for the toys?

How many children does your organization serve annually? *

NUMBER OF TOYS REQUESTING ANNUALLY FROM THE PTF
AGE GROUP	Number of toys needed annually
Infant (0-2 years) *
Toddler Boy (3-5 years) *
Toddler Girl (3-5 years) *
Boy (6-10 years) *
Girl (6-10 years) *
Teen Boy (11-14 years) *
Teen Girl (11-14 years) *

How will you promote the Pirate Toy Fund (i.e. mentions/links via social media, website, newsletters, ads, etc.)? *

Your Account Information (if accepted)

Set up Your account information in case we accept your application.

Account email address *

Account organization name *

Account representative name *

Account contact number *

Account password *

Account password repeated *