INFORMATION OF APPLICANT:
INFORMATION OF NOMINEE:
Relationship to nominee
Names and ages of the children they are caring for and their relationship with the children
Is the mother living or deceased? (If deceased, please list DOD)
If living, is the mother actively involved in the child’s life?
If actively involved, where is the mother employed?
Is the father living or deceased? (If deceased, please list DOD)
If living, is the father actively involved in the child’s life?
If actively involved, where is the father employed?
PLEASE SELECT ONE OF THE FOLLOWING TYPES OF SUPPORT THAT YOU FEEL THIS FAMILY WOULD MOST BENEFIT FROM —Please choose an option—CHRISTMAS FAMILY FUNDINGTUITION SUPPORTPAY A BILLREGISTRATION FOR ATHLETICSFOOD DRIVEOTHER (PLEASE DESCRIBE BELOW)
IF OTHER, PLEASE EXPLAIN
REFERENCES (Please list two or three references that know the nominee and are familiar with their situation)
Name and relationship
IN YOUR OWN WORDS, PLEASE EXPLAIN BELOW HOW AND WHY THIS FAMILY WOULD BENEFIT FROM THE SUPPORT OF THE PINK ELEPHANT MOVEMENT