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.

Potentially eligible individuals will be contacted by our team using 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