Fundraising Form

Domestic Violence Shelter and Services, Inc. (DVSS) welcomes the support of individuls and organizations of the Shelter and related programs.  Please read the following fundraiser guidelines for more clarity regarding the principles that govern our agency’s operation.

  • DVSS helps abused victims and their children.  Therefore, your group should choose an event that fosters positive family interactions and interpersonal equality.
  • DVSS believes that the use and abuse of alcohol often damages families, particularly when an abuser is also an alcoholic.  Therefore, DVSS encourages individuals and organizations who wish to sponsor fundraising events for benefit of the agency to refrain from offering alcoholic beverages as part of the event.  DVSS cannot be named as a beneficiary of an event for which the primary focus is the consumption of alcohol.  The Executive Committee of the Board of Directors must approve events where alcohol is present.
  • DVSS assumes no liability for whatever might happen before, during, or after the event.  We assume no part of the expenses for the event.
  • The event must be presented as your organization’s event for the benefit of DVSS.
  • If DVSS is not to receive all proceeds, this must be stated.  Any other recipients of proceeds must also be listed in the promotional materials.
  • All benefit events must include an educational component about DVSS, and on domestic violence in general.  At minimum, information about DVSS must be available to anyone attending an event through a visible display of agency brochures.

Please complete the form and submit.  You will receive a response within 1-2 business days.  If you have questions or if you require additional assistance, please contact the Director of Operations & Development at 910.343.9969 ext. 106.  Office hours are Monday-Friday from 9:00 a.m. until 5:00 p.m.


Downloadable PDF Form

Downloadable Word Form

Thank you for your consideration and support!

    Fundraiser or Benefit Name

    Event Location, Date, Time, and Entry Fee (if applicable)

    Organization or Sponsor Name

    Organization or Sponsor Street Address

    Mailing Address (if different from above)

    Contact Person

    Contact Person Phone Number (include area code if not 910)

    Email Address

    Confirm Email Address

    Briefly describe the fundraiser/benefit and approximate dollar amount you hope to donate to the Shelter.

    Does the event involve the serving of or consumption of alcoholic beverages?

    If yes, please explain.

    Describe any activities/tasks that agency staff will be responsible for completing.

    How will this fundraiser include an educational component for those attending the event or participating in the project?

    I/We agree to adhere to the fundraising/benefit guidelines set forth.

    Enter name of responsible party from fundraising organization.

    I/We certify that the above statements are true and correct to the best of my knowledge and belief. I understand that the willful misrepresentation or omission of facts may prevent the approval of my event. I release all persons and agencies from any and all liability which may be incurred as a result of obtaining and using this information in the approval process of this event as well as in the participation and/or attendance of this event.