Submit Qualifying Recipients

Name*
First Last
Organization*
Position*
Phone*
Email*
Enter Email Confirm Email
Recipient Details
School/Team/Club Name*
Contact Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Why are there financial limitations?*
Are their financial limitations a temporary or seemingly permanent challenge?*
How would receiving a custom canopy impact the recipient?*
Share their story. Please provide a detailed description of their circumstances and situation.*
Please send a copy of this form to this email address:
CAPTCHA
Would you like to submit another recipient at this time?*
- Yes
- No
Recipient Details
School/Team/Club Name*
Contact Name*
Address*
Street Address Address Line 2 City State ZIP / Postal Code Country
Phone*
Email*
Why are there financial limitations?*
Are their financial limitations a temporary or seemingly permanent challenge?*
How would receiving a custom canopy impact the recipient?*
Share their story. Please provide a detailed description of their circumstances and situation.*
Would you like to submit another recipient at this time?*
- Yes
- No
Recipient Details
School/Team/Club Name*
Contact Name*
Address*
Street Address Address Line 2 City State ZIP / Postal Code Country
Phone*
Email*
Why are there financial limitations?*
Are their financial limitations a temporary or seemingly permanent challenge?*
How would receiving a custom canopy impact the recipient?*
Share their story. Please provide a detailed description of their circumstances and situation.*

ACA Recipient Entry

Complete the form below to provide a list of potential recipients of a custom canopy through the Affordable Canopy Act.

First Name *

Last Name *

Organization *

Position *

Phone *

Email *

List Qualifying Recipient Below

Recipient

School/Team/Club Name *

Contact Name *

Address *

City *

State *

Postal Code *

Phone *

Email *

Answer the following questions about your Recipient entry

Why are there financial limitations? *

Are their financial limitations a temporary permanent challenge? *

How would receiving a custom canopy impact the recipient? *

Share their story. Provide details about their circumstances. *

Recipient Details