Today's Date:
*
/
Month
/
Day
Year
Date
The Nominator
*
First Name
Last Name
Address:
*
Nominator Info
Phone Number:
*
Nominator Infor
Email:
*
Nominator Info
The Nominee
*
First Name
Last Name
The Nominee (2)
First Name
Last Name
Age:
Nominee Info
Race:
Nominee Info
Gender:
Nominee Info
Email:
*
Nominee Info
PHONE NUMBER:
*
Nominee info
ADDRESS:
*
Nominee Clothing Size
Tops
*
XS
S
M
L
XL
2XL
3XL
4XL
Other
Bottoms
*
XS
S
M
L
XL
2XL
3XL
4XL
Other
Number of Children
*
Nominee's Children
*
Rows
Age
Gender
Shirt Size
Pant Size
Child 1
Female
Male
NonBinary
XS
S
M
L
XL
2XL
3XL
4XL
XS
S
M
L
XL
2XL
3XL
4XL
Child 2
Female
Male
NonBinary
XS
S
M
L
XL
2XL
3XL
4XL
XS
S
M
L
XL
2XL
3XL
4XL
Child 3
Female
Male
NonBinary
XS
S
M
L
XL
2XL
3XL
4XL
XS
S
M
L
XL
2XL
3XL
4XL
Child 4
Female
Male
NonBinary
XS
S
M
L
XL
2XL
3XL
4XL
XS
S
M
L
XL
2XL
3XL
4XL
Child 5
Female
Male
NonBinary
XS
S
M
L
XL
2XL
3XL
4XL
XS
S
M
L
XL
2XL
3XL
4XL
Child 6
Female
Male
NonBinary
XS
S
M
L
XL
2XL
3XL
4XL
XS
S
M
L
XL
2XL
3XL
4XL
Child 7
Female
Male
NonBinary
XS
S
M
L
XL
2XL
3XL
4XL
XS
S
M
L
XL
2XL
3XL
4XL
Nominee's Needs Assessment
*
Rows
Y
N
N/A
Notes
Are you/they in school?
Do you/they need education assistance?
Do you/they need help with parenting classes or resources?
Do you/they have a cell phone?
Do you/they need help finding stable housing?
Are you/they employed?
Do you/they need help finding stable employment?
Do you/they need any substance abuse treatment?
Do you/they need any behavioral health treatment?
if you are selected for our initiative, do you consent to being photographed and/or filmed for the The Love Project 404 marketing purposes?
Family Sponsorship Initiative
Known Monthly Expenses
*
Rows
$
Rent/Mortgage
Power/Gas
Water
Internet
Medical Expense
Other
Other
Other
Other
Other
Please describe any expenses above labeled "Other"
Please tell us why you nominated this family and identify what you believe is the nominee's most pressing critical needs.
*
Submit
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