Together We Can Help Application

Organization Name*
Is your organization:*
- For profit
- Not for profit
Organization website*
Organization address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Point of Contact*
First Last
Email*
Phone*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Description of the organization's cause/mission and who benefits. Also tell us why you think your organization would be a good fit with Healthy Living and our mission/vision/values.*
Upload your 501(c)(3) or other supporting documentation.
Max. file size: 50 MB.