Nomination Form Charities In order to be considered at a meeting, the organization must be based in the Southern Maine area. The organization must be a non-profit entity recognized as a 501(c)(3) for at least a year. No national or international charities, programs or organizations will be considered unless they have a location in the Southern Maine area, as the purpose is for the contributions to stay 100% in the community. ** Only members who have signed a COMMITMENT FORM and are current on their contributions may submit a charity for consideration. ** Charity Name * Include the organization's mission statement, populations served, other sources of funds, how funds are used, and any other pertinent information below. * Nominator First Name * Nominator Last Name * Nominator Email * Charity Email Charity Email 2 Charity Phone Charity Address * Charity Address Charity Address Charity Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Charity Website/URL Is the charity a 501(c)3 non-profit? * Yes No OtherOther Has the charity been a 501(c)3 for more than 1 year? * Yes No Terms and Conditions * I attest that I (the Nominator) am a current, up to date Member of 100+WWCSM and I agree to the above Terms and Conditions The organization agrees to not use, give, or sell the contact information of our members for additional solicitation by them or other organizations. reCAPTCHA Submit If you are human, leave this field blank.