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Form for Financial Assistance

Have you applied for funding with Medicine Wheel Ride in the past?
Yes
No
Is this request for an urgent or immediate situation?
Yes
No
What is the purpose of your request?:
Are you Indigenous or is the organization Indigenous led?:
Yes
No

For Organizations

We agree to provide Medicine Wheel Ride with information about how the financial assistance was used and the demographics of the recipients
Yes
No
Are you a 501 or 501(c)3 non-profit?:
Yes
No
Do you receive major funding?:
Yes
No
Other

For Individuals

Would you like Medicine Wheel Ride to feature a story about your loved one?:
Yes
No

For Individuals and Organizatiosn

Choose a grant amount you are requesting. Be aware that anything over $600 must be reported to the IRS and you will receive a 1099 form from us.:
$50
$100
$250
$500
Other

Please Note: Funds will be distributed via Check, PayPal, or Zelle.

Please be aware that if you are requesting funds for merchandize or purchased goods or services, you will be required to submit estimates and quotes from the most cost

effective vendors.


Medicine Wheel Ride will respond to all Request for Financial Assistance within 10 business days.


If this request is for an event, we require 30 days’ notice prior to the event.

Mandatory for Organizations, Optional for Individuals

If funded, do you agree to mention MWR or use our logo advertising or marketing?:
Yes
No
If funded, do you agree to complete our project progress report for inclusion in our annual report?:
Yes
No
Date
Month
Day
Year
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