NOMINATION FORM

Please complete this form to nominate someone in our community to receive a gift.  Please nominate individuals who are experiencing genuine need. This may include financial hardship, social isolation, loneliness, limited family/community support or another circumstance that makes additional assistance appropriate. Seniors are our primary focus, but other individuals in genuine need may also be considered.

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​Information submitted is used only to assess eligibility, coordinate the program and arrange gift fulfillment/delivery. Only limited, non-identifying information is displayed publicly for recipient selection.