GiftWorks LLC

  • Recipient Readiness Application

  • Important — Please Read Before Continuing

    This application is for kidney transplant recipients who are interested in participating in the GiftWorks Program.

    If you are completing this application on behalf of a recipient (for example, as a family member), please confirm that:

    • The recipient wants to participate in the GiftWorks Program.
    • The recipient is aware this application is being submitted.
    • All answers are provided from the recipient’s perspective.

    If the recipient has not reviewed or approved of this application, please pause and speak with them before continuing.

  • Who is completing this application?*
  • Patient's Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Gender*
  • What is your marital status?*
  • Do you have children?*
  • What is your employment status*
  • What is your primary language?*
  • Which race do you identify with? (Select all that apply)

  • We ask this question for internal program evaluation and equity analysis only. Your response will not affect eligibility, readiness scoring, selection, or participation in the GiftWorks Program. Answering is optional.

  • Which best describes your current treatment status?*
  • How long have you been on the kidney transplant waitlist?*
  • Have you received a kidney transplant in the past?*
  • This program requires approximately 2-3 hours per week for outreach, learning, and activities over the course of one year. Which best describes your ability to commit?*
  • If accepted into the GiftWorks Program, are you willing to: (check all that you agree to do)
  • After submitting this application, would you be willing to schedule a short orientation call within the next two weeks?*
  • Which best describes your current social media use?*
  • Which statement best describes your current approach to asking others to help support and share your living donor search?*
  • Have you previously shared your need for a living kidney donor?*
  • Is there at least one person who has agreed — or whom you are confident would agree — to actively help you share your living donor search with others?*
  • If Yes, who would that support most likely come from? (Select all that apply)
  • Do you have close family members or friends who are active on social media and can help share your living donor search online?*
  • Have any living donor candidates stepped forward to donate to you in the past?*
  • If you answered "yes" to the question above, do you know how many living candidates stepped forward to donate to you in the past?

  • Program Participation Acknowledgment & Commitment

  • I understand that, if accepted into the GiftWorks Program, I will be asked to actively participate in sharing my search for a living donor with my community. This may include sharing on my social media platforms and communicating directly with people I know.

    I understand that my involvement and engagement are critical to the success of this program.

    I agree to actively engage with the GiftWorks team, follow program guidance, and seek appropriate opportunities to share my search for a living donor with my network.

    I understand that participation in the GiftWorks Program requires a time commitment of approximately 2–3 hours per week, which may include completing activities, attending online education sessions, and participating in group discussions.

  • Should be Empty: