** This form is to be completed to request a monetary donation for events that are hosted by not for profit groups other than the National Wheelcats, Inc.
Thank you for your interest in the National Wheelcats, Inc. Please read, complete and return the form below to the appropriate sport director by email, mail or fax.
** For a list of Sport Directors and their email addresses are click About Us on the website www.nationalwheelcats.org
All donations will be considered and allotted based on availability. All donations are at the discretion of the National Wheelcats “NWC” Officers.
Donations may not be used for “prize money”. We encourage the participation of wheelchair athletes in sporting events and prefer donated money be used for housing, travel and
Interested “event” host MUST provide the NWC with the following information to be considered for receiving a donation:
** completed donation form with the following items attached:
* 501 (c) 3 documentation
*event literature (entry form from previous or current year’s event)
*brief description of how donation will be used to benefit wheelchair athletes
Name and location of the Event:___________________________________________________________
Brief description of the event and how wheelchair athletes will be involved: _____________________________
Date(s) of the event :_________________________
Name of the group hosting the event:____________________________________________
** documentation of 501 (c) 3 is required
Representatives name requesting funds (person directly involved with event host organization):
Representative Phone Number: (____)_________________
Check payable to: ________________________________
Address: Street: __________________________________
City: ___________________ State: ____ Zip Code: __________
What is the representatives role with the listed event? _____________________________________
How many athletes will be participating in this event? Number of able bodied: ____
Number of wheelchair athletes: ____
TOTAL Donation Amount Requested: $_________________
The amount requested will be used in what way? Please be specific.
If the National Wheelcats Board approves your donation request, do you agree to provide the following within 3 weeks after the conclusion of the event?
*names and hometown of all wheelchair athletes who participated in the event
*evidence of the NWC logo on event flyers, newspapers, entry forms etc…
*appropriate receipts of hotel and entry fee paid for by the National Wheelcats, Inc.
Sport Director signature:______________________________________Date:__________________