In-Kind Donation Form Donor Contact Name* First Last Donor Company Name (if applicable)Donor Contact Email Enter Email Confirm Email Donor Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Item(s) List*Please include detailed description, quantity and value of items donated. There is no word or character limit. This information will be included in your tax receipt. If the value is unknown or priceless, please enter $1.ItemDescriptionQuantityValue To be completed by UF Health employee securing item(s):Date items received by UF Health* Item secured for:*Child Life ProgramChildren's Miracle Network HospitalsHematology/Oncology - PediatricHematology/Oncology - AdultNICUUF Health Shands Children's HospitalUF Health Volunteer ServicesEvent (enter below)Other (enter name of unit below)Event NameUnitEmployee Name* First Last Employee Phone*Employee Email* After submitting, you will receive a confirmation email, and this form will be submitted to UF Health Office of Development Gift Processing. For more information, call 352-265-7237.