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Donation Requests

Request for Community Donations

At Rose Dental we have a strong commitment to community. When possible we enjoy giving our time, products, services, and monetarily to organizations in the Austin and surrounding areas. We feel it is important to give back to those that help support us and we encourage our employees to do the same. Our employees are involved, throughout the year, in various volunteer opportunities.

If you would like to request a donation or offer a volunteer opportunity to us, please fill out the online request form below. Please allow 30 days for a response to your request.  

Organization Information

Organization/Group Name:
Contact Name & Title:
Phone Number:
Fax Number:
Federal Tax ID Number:
5.01 (c)3 non-profit?:  Yes     No
Please describe the purpose of your organization and its primary beneficiaries.

Event Information

Event Name:
Event Coordinator Name:
Event Location & Physical Address:
Event City:
Event State:
Event Zip:
Event Phone Number:
Event Fax Number:
Is this event a Fundraiser?:  Yes     No
Event Date:

Event Description (Time, Number of people to attend, Purpose)

Which community or neighborhood will benefit from this donation? 

What other Businesses will be involved? 

What is the total goal of the fundraising activity? 

Briefly describe the timetable for program activities:

What target population is to be served?
What is the deadline for receiving the donation? (90 day minimum)
Have you held this event before?  Yes     No
Is this an annual event?  Yes     No
Number of people attended?
Did we donate to this auction in the past?  Yes     No
If yes, what was the item, its value and what did it sell for?

Request Information

What value amount are you requesting for a donation? Please be specific about what you are requesting.

Has Rose Dental Group donated to your organization in the past?     Yes     No

If yes, please specify the event, donation and the date.

How will Rose Dental Group's contribution be included in advertising, program promotion or public acknowledgement?

Will Rose Dental Group receive complimentary tickets to the event?   Yes     No

If so, how many?  

Donation Agreement

If donation is granted, we may request you to pick up the donation.

I agree that the above information is accurate. I understand that this is a request form only and that I will not receive a donation from Rose Dental Group until the request has been confirmed by Rose Dental Group.

Submitter Name:

Submission Date:


You may request an appointment online, via live chat, by calling us, or by email.

We have four convenient locations to serve you!

11615 Angus Rd., #110, Austin, TX 78759
P: 512-795-9643 • F: 512-795-9959

6211 W. William Cannon Dr., Austin, TX 78749
P: 512-288-4447 • F: 512-288-4774

893 N. IH-35, #200, Round Rock, TX 78664
P: 512-310-9374 • F: 512-244-3954

1450 W. Parmer Ln., Austin, TX 78727
P: 512-251-6125 • F: 512-251-6126


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