This is a test page. Nominations submitted using a form from this page will NOT be considered.

First Name*
Last Name*
Phone*
Email*
Date of Birth "mm/dd/yyyy" (must be 18 or older) *
Charity*
What City is the Charity located in?*
What State is the Charity located in?*
Charity Website (if known)
Charity Mission Statement (if known)
Charity Contact Name*
Charity Phone Number (if known)
Charity Email (if known)
Is This a Parent/Teacher Organization
In 148 words or less, describe how this organization supports K-12 public education or school-age kids. Please include specific programs and ways the organization works with K-12 public schools, students and/or has been impacted by Covid-19.*
In 148 words or less, please share why this charity logo should be featured on Jimmie’s helmet and why it is important to you. *
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