Golden Ticket Award form

The Golden Ticket Award

A monthly $100 grant for deserving individuals with special needs

Please fill out the form below to submit online. We must have a means to contact the individual you are nominating as well as his or her parent/guardian or residential provider to confirm the individual’s disability and financial need.

In the field below where you explain how this award would benefit the nominee, you may choose to upload a document (DOC, DOCX, PDF, RTF, ODT) instead of entering text in the field. This could be especially useful if you’re submitting on a smart device such as iPad or Android phone.

Alternatively, you may download and the print the PDF version and follow printed instructions. Thanks!

The Nominee's Information
  1. (required)
  2. (required)
Parent/Guardian and/or Residential Provider
  1. (required)
Nominating person's information
  1. (required)
  2. (required)
  3. (required)
  4. (valid email required)
  5. How will this individual benefit from receiving this grant? Please be as specific as possible with your reason(s) for nominating this special needs individual.
 

cforms contact form by delicious:days

« Return to all Forms