Alternative Recycling Program 1st Time Applicant

Alternative Recycling

First Time - Applicant Registration Form
Alternative Recycling Program Overview

MedWish partners with domestic nonprofits (including animal shelters and schools) to repurpose supplies unfit for humanitarian aid distribution. These supplies are no longer sterile and/or are expired, and therefore cannot be distributed for medical use.

The items listed in this application are commonly kept in our inventory. If there are other expired/non-sterile supplies you are interested in receiving for non-medical use that are not on the list below, you may submit your request for consideration. Those interested in receiving supplies should complete the form below, or contact us at info@medwish.org or (216) 692-1685 x22 with questions.

Please note, recipients must come to MedWish International to receive or select the supplies. Pick-ups are by appointment only.
Name of receiving organization: *
Primary Contact*

First NameLast Name
Title of Contact at Receiving Organization
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Website*
Social Media Handles
I am requesting donated supplies to support*

An animal shelterEducational Institute and/or Student-led OrganizationIndividualOther
Approximate number of clients served annually*
Please provide proof of nonprofit status by either uploading supporting documents or completing the narrative below.

Browse Files

Cancelof
If nonprofit status documents are unavailable, please provide a narrative on the charitable/nonprofit nature of your work.
How did you hear about this program?*

I've volunteered at MedWish beforeInternet searchI was referred by someoneOther
If you were referred to MedWish by a person or organization, please let us know who:
LOGISTICS - Does the organization have the ability to pick up the donations?*

YESNO
WISH LIST & Project Information

These itms are availble because they are non-sterile or expired, making them inappropriate for humanitarian use. They are availble for donation to support charitable/educational non-medical activities within the United Stated. Please select the items from our Alternative Recycling standard inventory that you wish to request. Your final supply donation is dependent on our availble inventory and on approval of this application.
Select requested items:*

Cotton ballsCotton Swab ApplicatorsDrapesGauzeGownsLap PadsLatex GlovesMasksMeasuring CupsMeasuring TapesNon-Latex GlovesOR TowelsPaper CupsPaper TowelsPipetsPlastic BowlsPlastic Bowls (Kidney)Plastic ContainersPlastic Containers with LidPlastic CupsPlastic ForcepsPlastic TubingScalpelsScrubsSponges with HandlesSyringesTapeTourniquetsOther
If you selected "Other", please explain the intended use for these items in the space below.
RELEASE STATEMENT

The above requested item(s) will be released to an approved MedWish domestic Alternative Recycling Recipient (ARR). The ITEMS are designated to be repurposed for educational, artistic, and/or veterinary purposes. The ITEMS may not be used for any other purposes including, but not limited to, the medical diagnosis, care and/or treatment of human beings. Nor may the ITEMS be monetized by way of resale or reprocessing for commercial purposes. ARR acknowledges that the ITEMS will be accepted without warranty, “as is,” and may not be free of defects. In no event will MedWish International be liable to ARR for any consequential, incidental or indirect damages, whether foreseeable or unforeseeable, arising out of the use or inability to use the ITEMS, regardless of the basis of the claim.
Signature*

Clear
Applicant's full name*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty: