Submit a Future Beneficiary

If you, or someone you know, could use financial assistance due to illness, tragedy, disaster, or similar causes please fill out the submission form below. Local non-profit organizations in need of financial assistance are also encouraged to apply. Eligible individuals and organizations will be contacted by our team through the information provided.

Your name

Your e-mail

Your phone number

Potential Beneficiary Name

Please concisely describe the circumstances surrounding the need for financial assistance

Please describe in what way(s) the potential beneficiary would benefit from a fundraising campaign

Anything else to add?

If you are submitting on behalf of someone else, is this person aware you are reaching out to us? Yes No