Nomination Form
Please complete the form below to submit your nomination
Nominee Information
Nominee's Full Name
*
First Name
Last Name
Nominee's Age
*
Must be elementary school age or older, up to age 18
Basis for Nomination: Please describe obstacles or challenges this child has overcome.
*
Nominator (GAL/CAM) Information
Nominator's Full Name
*
First Name
Last Name
Nominator's Phone #
*
Nominator's Email
*
Nominator's Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
CAM
*
Are you a Guardian ad Litem Volunteer or Staff member?
Award specifications
Choose the type of certificate and the type of gift card for your nominee. $25 gift cards for ages 12 and under; $50 gift cards for 13+. Award certificate and gift card will be sent to the Nominator for delivery to the nominee.
Award Certificate
*
Elementary age
Middle School age
High School age
Gift Card type
*
Amazon
Chick-fil-A
Cold Stone Creamery
Five Guys
McDonald's
Game Stop
Best Buy
Ulta
Sephora
Books A Million
Barnes & Noble
VISA
Target
Walmart
Other - please list
Other gift card type:
Please list gift card preferred if not listed above
Additional information
Upload picture or supporting file(s) if needed
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