Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Name *

First Name

Last Name

Phone *

(###)

###

####

Is charity 501(c)(3) *

Yes

No

Will 100% of donation stay local and provide services to those in the Rochester area? *

Yes

No

Does charity serve: *

Children Only

Children and Women

Women Only

Families

Does charity have an annual report, if yes please include annual report:

Yes

N0