Feed the Lion: Monarchs Give Back-Collection Bin/Fill-A-Bag Request Form

Thank you for helping us "Feed the Lion"! Please use this form to request a collection bin or Fill-A-Bag for your department, college, or unit. Once your request is received, a member of our team will follow up with delivery details and additional information. ***Please note due to delivery capacity donation bins can only be delivered to the main and medical campus at this time.***

Department/College/Unit/Organization/Club Name *
Primary Contact Person
Name: Name: * First Last
Title/Role: *
Email: *
Phone: Phone: * - ### - ### ####
Physical location for Bin Placement:
(Building name, floor, room number, or common area)
Physical location for Fill-A-Bag Drop Off:
(Building name, floor, room number)
Preferred Bin Delivery Date: Preferred Bin Delivery Date: / MM / DD YYYY
Preferred Bag Delivery Date: Preferred Bag Delivery Date: / MM / DD YYYY
Will this bin be shared across multiple offices or departments?

Will this bin be shared across multiple offices or departments? N/A No Yes-please list: Yes-please list:
Expected Traffic/Volume:

Expected Traffic/Volume: High (building lobby or main office) Medium (specific department office) Low (special event or small collection)

Feed the Lion: Monarchs Give Back-Collection Bin/Fill-A-Bag Request Form

Feed the Lion: Monarchs Give Back-Collection Bin/Fill-A-Bag Request Form

Primary Contact Person