DESIGNATED GRANT FORM Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Designated Grant Form 2023-2024 Thank you for your outstanding support of BVL and the veterans we serve. We value the important role you play in helping us achieve our goal to brighten veterans' lives. BVL provides funding for recreation therapy programs that are not covered by government funding – programs that are instrumental to the recuperation of America’s wounded heroes. Please consider allocating a portion of your funds to BVL National so that we can continue these vital programs throughout the U.S. Business Name *Contact Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *LayoutTotal Donation Amount *Amount to BVL National *Please allocate the above amount to BVL NationalOther Designated Funds: If desired, please indicate which facilities you would like fund to be sent to. Facility *Contact *FirstLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAmount Designated *Do you wish to designate to a 2nd facility?YesNoName of 2nd Facility *Address of 2nd Facility *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAmount Designated to the 2nd Facility *Do you wish to designate to a 3rd facility?YesNoName of 3nd Facility *Address of 3rd FacilityAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAmount Designated to the 3rd Facility *Grant Checks: How you would like the grant checks to be sent and/or presented? * Please note that grant check must be deposited within 90 days. * OPTION 1 How would you like to receive your grant check(s)?I/we would like the grant check(s) mailed to our organization so it may be personally presented.If above is selected, please choose from below:(Y/N) regular-sized check(s) to present to the facilityoversized check(s) to present to the facility (best for a photos to share!)OPTION 2 How would you like to receive your grant check(s)?OPTION 2: Mail a check directly to the VA facility(s) listed above.___________________ Your request will be processed within 30 days. Submit
