Nomination Form

Recipient Information
Recipient Name*
First Last
Gender
- Male
- Female
Birthdate*
MM
DD
YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Senior Living Community Name (if applicable)
Check all that apply*
- Elderly
- Disabilities
- Chronic Illness
Upload Pictures of Recipient (optional)

Nominator Information
Is nominator same as recipient?*
- Yes
- No
Name*
First Last
Relationship to Recipient
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email

Getting To Know Recipient
If you are nominating someone, please remember that the questions below refer to the recipient. Be as detailed as possible with your answers.
What are some of the recipient’s interests, hobbies, and passions? Do they still participate in any of these today?*
What occupations have they had?*
What positive impact has the nominee had on those in the community?*
What is something the nominee wish they could do but currently are unable to?*
Are you a military veteran?*
- Yes
- No
Are you a legal resident or citizen of the U.S.A.?*
- Yes
- No
Have you ever been convicted of a crime?*
- Yes
- No
Are there any accommodations that we would need to plan for in helping you? (ie, wheelchairs, oxygen, care giver, dementia, etc.)*

Project Description
Describe the need of the nominee in detail.*
Why is this important to the nominee and how would it effect them and their loved ones. (physically, mentally, emotionally, spiritually)?*
What limitations are there for the nominee to complete this on their own.*
Has the nominee ever been a recipient of a nonprofit before?*
Disclaimer
By submitting this nomination form, I acknowledge that acceptance of this nomination by The ELF Project does not constitute a commitment by The ELF Project to fulfill this request. If the nomination moves to the next stage, an ELF Project representative will contact me for more information. I understand that this contact also does not constitute a commitment to grant my request. Furthermore, I certify that I meet all qualifications for eligibility, and declare that all of the information given by me in this application is true to the best of my knowledge, and I agree to inform The ELF Project in a timely manner should any information provided in this application change.

Recipient Information