Printer Friendly

This form must be completed in its entirety to request a charitable donation from CVR Energy, Inc. and its subsidiaries (collectively, "CVR"). CVR only accepts requests from non-profit 501 (c)(3) organizations that specifically relate to our five community impact areas: Youth, Education, Health & Human Services, Environment and Culture.

Please submit this form along with a current W-9 PDF document. Please note that charitable giving requests are processed on a quarterly basis and require no less than 60 days’ notice. For more information, please email

Dates less than 60 days away cannot be entered.
(Only PDF or PNG file formats allowed.)