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Self Excluded Jackpot Request



Self-Excluded Jackpot Request

Online applications are open June 1 – 30, 2024. Requests will be accepted in June of each year for an October pay-out. All Submissions must be an Arizona-based non-profit, primarily dedicated to the treatment or prevention of problem gambling or other addiction treatment services.
Name of your organization
MM slash DD slash YYYY
Please include today's date
Are you a Gila River Indian Community Entity?(Required)
Address

Requester Contact Information

Name

Supporting Documentation

Please upload the following documents: Certified 501(c)(3), Copy of W9, Annual Report, BOD Members, and any other documents you want to include to assist us in our decision.
Max. file size: 512 MB.
Max. file size: 512 MB.
Max. file size: 512 MB.
Max. file size: 512 MB.
Max. file size: 512 MB.