Donation Request Form

Since its inception in 1934, Home State Bank has continued to go above and beyond in providing monetary support to numerous organizations and causes.  Additionally, our employees contribute countless volunteer hours in the communities they work and live.  Giving back is one of our core beliefs and we intend to continue this strong tradition.

If your organization is interested in requesting monetary support from Home State Bank or the Home State Bank Charitable Foundation,  please complete our Donation Request Form, below.  We make every effort to support as many sponsorship and donation requests as possible.  However, due to the large number of requests we receive, we may not be able to fulfill every request, and completing this form does not guarantee a donation.  

Please note that each application is reviewed by Home State Bank on an individual basis.  We ask that requests be submitted 5 weeks before your event to allow us time to review each application.  Should a request be made in person, forms will be available in our lobby.

Contact Information

*  - Indicates required fields

Organization Name *

Organization Address

Organization City

Organization State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Organization ZIP

Is your group or organization a 501(c)(3)?

Yes No

Event Name (if applicable)

Event Beneficiary (if applicable)

Event Date

Donation Amount or Gift Item Requested *

What percentage of the donation will be used to fund the mission and what percentage of the donation will be used to cover event expenses? *

Contact Name *

Contact Email Address*

Contact Phone Number*

Does your group or organization have any connection to Home State Bank? (i.e. who and their role: employee, board member, etc.) *

Please attach any additional materials regarding your request (if applicable).

Return this packet and additional materials to:

Jackie Cunningham
jcunningham@hsbank.net

Home State Bank
Attn: Donation & Sponsorship Requests
115 West State Street
Jefferson, IA 50129

Our Sponsorship & Donation Committee meets monthly. The deadline for a sponsorship request is 5 weeks prior to your event.

A member of our committee will reach out once a decision has been made.
We wish your fundraising efforts much success!