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Self Excluded Jackpot Request



Self-Excluded Jackpot requests are accepted June 1–30 each year for an October payout. TO BE CONSIDERED FOR THESE FUNDS, ALL APPLICANTS MUST BE:

  • Arizona-based Nonprofits
  • Focused on problem gambling OR addiction treatment

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.

 

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