Library Donation Form - Waves of Giving Campaign

Please print and complete this form and include it with your donation, so we can properly direct your gift and ensure accurate donor recognition.  
If you are donating online, this information will be collected through the online form and you do not need to submit this paper version.

Make checks payable to:
Friends of the Middletown Library

Mail or drop off at:
700 West Main Rd.
Middletown, RI 02842

Memo line:
For the new library building
 

Thank you for supporting the Middletown Public Library’s Waves of Giving Campaign!
 
Donor Information (Required):
Donor Name(s): __________________________________________________________________________

Organization (if applicable): ________________________________________________________________

Mailing Address: _________________________________________________________________________

City / State / ZIP: ________________________________________________________________________

Phone: __________________________   Email: ________________________________________________

Gift Information (Required):

Donation Amount: $______________________________________________________________________

Method of Donation:
☐ Check made payable to the Friends of the Middletown Library (mailed or dropped off to the Library)
☐ Donation or pledge arranged through the Town of Middletown

☐ My employer offers a matching gift program

Public Recognition Preferences (Required):

Would you like your gift to be publicly recognized?
If yes, please indicate how you would like your name(s) or organization to appear in recognition materials:

_______________________________________________________________________________________

☐ I/we wish to remain anonymous in all public recognition

Recognition Level (Optional):

☐ Ripple ($0–$999)
☐ Swell ($1,000–$9,999)
☐ Tide ($10,000–$24,999)
☐ Sea ($25,000–$49,999)
☐ Horizon ($50,000–$99,999)
☐ Anchor ($100,000+)

Direct Your Gift (Optional):

Would you like us to direct your gift toward a specific area of interest?

☐ Technology & Digital Access
Supports public computers, printing and scanning, audiovisual systems, assistive technology, and access to digital resources.

☐ Innovation Center & Maker Learning
Supports hands-on learning through cooking, crafting, digital fabrication, and creative technology for all ages.

☐ Children’s Learning & Play
Supports early literacy, learning-through-play, and engaging spaces for children and families.

☐ Study, Work, & Private Spaces
Supports quiet rooms and pods for studying, meetings, telehealth, and remote work.

☐ Outdoor Learning & Community Spaces
Supports gardens, outdoor programs, performances, and welcoming spaces beyond the library walls.

☐ Community Gathering & Program Spaces
Supports meeting rooms, furnishings, and amenities for programs, events, and community use.

☐ Welcome, Access, & Wayfinding
Supports entryway improvements, signage, accessibility features, and first impressions for all visitors.

Volunteer Interest (Optional):

☐ I am interested in helping with fundraising or donor outreach for the new library.

Areas of interest or skills (optional): __________________________________________________________

Additional Notes or Recognition Preferences (Optional):

_______________________________________________________________________________________

_______________________________________________________________________________________


Authorization (Required):

Signature: _____________________________________________________   Date: ___________________

Please include this form with your donation check. 
If donating through the Town of Middletown, please also complete the Town’s donation or pledge form.