Beneficiary Application

Apply to be next year’s (2023) Beneficiary

Fill out the form below and submit by September 24th, 2022 to qualify or Download Electronic Form Here.

Organization Name*
Organization Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Point of Contact Name*
First Last
Email*
Phone*
IRS NON-PROFIT DETERMINATION FEIN#*
MISSION STATEMENT - 100 WORDS OR LESS*
EXECUTIVE SUMMARY - 500 WORDS OR LESS*
GROUPS SERVED - Affiliated Entities*
PERFORMANCE METRICS - 150 WORDS OR LESS*
SHORT AND LONG TERM GOALS - 150 WORDS OR LESS*
WHO, FROM YOUR ORGANIZATION, WILL WE MEET AT THIS YEAR’S RACE ON SEPT 25TH? - NAME AND TITLE*
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Phone
This field is for validation purposes and should be left unchanged.