Please note that resources are being collected on an ongoing basis and, as such, donations will be disseminated as they are secured. In an attempt to support as many of our members as possible, we may restrict the amount of financial or in-kind donation that can be requested. If we are unable to provide your organization with the full extent of your request, we will make every attempt to circle back to you if/when further resources are secured. Together, we are America’s behavioral health network.

If you have any questions about the application, please reach out to Jeremy Attermann (JeremyA@thenationalcouncil.org) and Nacha Srinakarin (NachaU@thenationalcouncil.org)

*Please note that the National Council is serving as a connecting mechanism for all in-kind donations. While we will do everything we can to ensure that in-kind donations or services are offered as seamlessly as possible, we cannot ultimately claim responsibility for the quality of in-kind donations or services.

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* 1. Address of organization (please list address at which deliveries are received)

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* 2. Is your organization a member of the National Council for Behavioral Health? For a full list of our members, please check our website.

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* 3. 501c3 Tax Identification Number/EIN #

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* 4. The National Council has access to the following in-kind donations, funds, and free resources. Please select which of the following you would like to receive:

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* 5. If unrestricted funds are requested, please identify the specific items/purposes for which funds will be used. You may choose more than one option.

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* 6. If unrestricted funds are requested, please indicate your funding request amount. Note that while the National Council will make every attempt to provide funding and support, we cannot guarantee the full amount requested. At this time, please keep your requests up to $1,000

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* 7. In order to expedite funding, we will be processing funding requests through ACH payment. Please confirm that you can process funding through this method.

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* 8. Please submit your organization's ACH information. Please note that this information will be securely stored on the National Council's server. 

If you prefer to submit your ACH information via email, please email NachaS@TheNationalCouncil.org and JeremyA@TheNationalCouncil.org

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* 9. To expedite payment process, please upload your organization's W-9

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