Dollar Club Nomination
Thank you for nominating someone for the “Dollar Club.” The following nomination form is required for consideration by the Dollar Club. Please complete all questions as indicated below. If nominating a worthy organization, please include a contact name. PLEASE NOTE: Following receipt of your nomination form you will not be contacted again unless additional information is needed. We respectfully ask: please do not contact anyone on our staff regarding the decision-making process or status of your request. If your nominee is selected, they will be notified.
STEP 1: TELL US ABOUT WHO YOU ARE NOMINATING
Nominee Name(s) or Organization
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Marital Status
*
Married
Single
Other
Has this person been nominated before?
*
Yes
No
Other
Does the nominee attend church anywhere? (Please note you do not need to be a partner at Parkside to be nominated)
Yes
No
Other
Names and relationships of other adults living in the household. *Please include first and last name, and relationship--- one person per line
*
Any children living in the household? If so, what are their names and ages?
*
Immediate Financial Need- Why does nominee need Dollar Club assistance?
*
Overall life situation- What has caused the nominee to be in this situation?
*
STEP 2: TELL US A LITTLE ABOUT YOU
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Relationship to the nominee:
*
Are you a partner at Parkside? *Please note: you do not need to be a partner at Parkside to nominate someone for the Dollar Club
Yes
No
Submit
Should be Empty: