Change for Change Recipient Nomination

Your contact information

Name of person filling out this form

Email of person filling out this form

This address will receive a confirmation email

Phone number of person filling out this form

Organization contact information

Your organization must have 501(c)(3) status or have fiscal sponsorship from a 501(c)(3) organization, such a FUSiON Partnerships.

Organization name

Organization website address

Contact person, and their role.

Organization phone number

Organization Address

Description of organization, and nomination statement

Mission

Expected use of change for change funds

Are there any ways that our members could be involved in, or support this organization? (such as volunteer opportunities, supply drives, organizational support)

Please describe your own experience with this organization, or anything else you would like to tell us about why you have nominated it.

Description

Please fill out this form and click submit.

Change for Change Recipient Nomination

Description

Please Fix the Following