Nomination Form

Charity Nomination

Nominate Your Favorite Charity

Name of charitable organization:

Name of organization contact and/or executive director (include name, phone number and email address):

Organization Website:

Is this organization a registered 501(c)(3)?

Provide the organization’s EIN # (required):

How long has the organization been in existence (required minimum of 2 years)?

Does the charity currently serve Canadian County?

Will 100% of the funds awarded by the Power of 100cc stay in the Canadian County area?

Mission Statement and/or purpose of the organization:

How will the donated funds be used?

What population does the Organization serve?

Approximately how many people receive services annually from this Organization?

This nomination is made by (include member’s name, phone number and email address):

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