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Charity Name *

Please list your charity name as it should be shown on website and in our database.

Mission Statement & Description of Organization *

EIN # *

Employer Identification Number (format: XX-XXXXXXX)

Number of People Served Annually *

Year Founded *

Does your organization serve at least 51% diverse populations? *

Yes No

What group(s) comprise 51% of people served by the program? *

African American American Indian or Alaska Native Asian Hispanic, Latino or Spanish Native Hawaiian or Pacific Islander White Other N/A

Does your program focus on any of the groups identified below? *

Persons with disabilities LGBTQIA+ Veterans Women N/A

First Name *

Last Name *

Title of Contact Person *

Organization Address *

City *

State *

Zip Code *

Email *

Phone Number *

(do not include dashes)

Participation of charitable organizations will be reviewed based on the following criteria: *

501(c)(3) status as recognized by the IRS We are a school We are a church/private organization We are a government organization

Please attach your 501(c)(3) determination letter from the IRS here. Only PDF files accepted.

Captcha *

Charity Sign-Up