Fields marked with an asterisk (*) are required
Company Name
*
Store Name
Store Number
Store Address
Street Address
Street Address Line 2
City
State
Zip Code
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Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Your Phone Number
-
Area Code
Phone Number
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Legal Name of the Charity
*
Charity Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Charity Contact Person
*
First Name
Last Name
Charity Contact Email
*
example@example.com
Charity Contact Phone Number
-
Area Code
Phone Number
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Please indicate the area of service that this nonprofit organization provides
Housing/Homelessnes
Civic/Cultural Issues
Youth
Community Rebuilding/Neighborhood Revitalization
Other
Please provide a brief description of how you have worked with this charity and why you’d like to partner with them
Submit your Nomination
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