Date: _____________________
Contact Name:
Phone: Email:
Mailing Address:
Name of person/business to be acknowledged in donation receipt: ________________________________________
Designated Donation: Undesignated Donation:
Angel House Shelter Scattered Sites Shelter Undesignated, Local Use Only
Carriage House Shelter Welcome Home Baskets
Village at Cataumet Shelter Family Care Packages
If gift designation is not listed above, please name the specific project/event to which donation will be applied:
Donation Type
Monetary Gift Materials/Products/Services Skilled Labor
Pledge to Be Invoiced Volunteer Time (not tax deductible)
Donation Description
Product Donations: Please list the items to be donated (may use check-list on page 2 or attach a list)
Volunteer Time: Task (i.e. collecting/delivering donation):
________________________ Total Hours: _______
Donation Value
Cash Contribution: $ ________________________ * Pledge Amount: $ ________________________
Estimated Fair Market Value of Non-Cash Contribution: $ ________________________ *
*All donation values must be assigned by the donor.
As a 501(c)(3) organization, donations to Housing Assistance Corp., in excess of goods or services received by the donor, are
tax deductible to the full extent of the IRS code. This form serves as the official receipt for your gift. Housing Assistance Corp.
does not assign the estimated fair market value as this is the responsibility of the donor for IRS purposes. We do note include
this value in our financial reporting on Form 990. Thank you for building communities and hope on Cape Cod & the Islands!
____________________________________________ ___________________________________________________
Signature of Person Authorizing this Donation Signature of Housing Assistance Corp. Representative
click to sign
click to edit
click to sign
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We’re so thankful for our community members who want to donate specific items to
our family shelters! It can be a complicated matter organizing these donations and
we have limited sorting and storage spaces, so we’ve established general guidelines
for donating items to our shelters. We are only able to accept new, unopened items
for Family Care Packages for our shelter clients or our Welcome Home Baskets for
families moving from shelter into a permanent home.
The Donation Form, Donated Item List and donations listed below can be brought to Housing Assistance offices
at 460 West Main Street in Hyannis and we will bring them to the family shelters. Any questions, please call (508)
WELCOME HOME BASKETS (New & Unopened Items)
____ Full Size Sheets
____ Twin Size Sheets
____ Cooking Utensils (bundle of spatula, flipper,
whisk, slotted spoon)
____ Shower Curtain
____ Shower Curtain Rings
____ Broom
____ Dust Pan
____ Toilet Brush
____ Silverware
____ Kitchen Towels
____ Gift Cards for Other Miscellaneous Items
____ Melamine Dish Sets (dinner plates, bowls, small
____ Pots and Pans
____ Silverware sets
____ Unbreakable drinking glasses
____ Laundry baskets
FAMILY CARE PACKAGES (New, Unopened Items)
____ Diapers (all sizes)
____ Baby Wipes (especially sensitive wipes)
____ Children’s Bibs
____ Standard-size bed pillows
____ Bath towels sets
____ Twin sheets
____ Twin size cotton blankets
____ Toddler bed/crib sheets
____ Pack and play sheets
____ Rubber Flip-Flops (all sizes for adults)
____ Toiletries
____ Dental floss
____ Deodorant
____ Disposable razors
____ Shampoo & Conditioner
____ Shaving cream
____ Tampons
____ Toothbrushes (both for adults and for
____ Toothpaste (both for adults and training non-
fluoride training toothpaste for ages 3 months to
4 years)