IMPACT Award Entries

An entry must be filled out for every donation, referral, or drive hosted that you want to count towards your award no later than April 15 (spring) or Nov. 15 (fall) of your graduation year. Please note, deferrals (e.g., incomplete donations) do not count towards your award.

Name *

Email *

Your Donor ID

If you have ever donated with us, you have a Donor ID! Please email impact@mvrbc.org or call 800-747-5401 to find out your donor ID number.

Name of High School *

State (where school is located) *

I am filling out this form because:

I donated blood or platelets:

I just made a personal donation! Yes
No

If yes, enter date of your donation (or leave blank if no).

Select donation type (choose N/A if no):

A new donor I recruited just donated! Yes
No

If yes, enter date of their donation.

Recruited a Donor:

Name of Recruited Donor

Donor ID of recruited donor:

Hosted a Blood Drive

I hosted a Blood Drive! Yes
No

Date of Blood Drive

Location of Blood Drive

I want an update on how close I am to receiving my award. Yes
No

Opt me into text messages so that I get updates from the Blood Center. Yes
No

If yes, please provide cell phone number otherwise leave blank:

Any additional comments/questions?

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