Sparking Light Application Form
Please thoroughly fill out this form for a family that has recently lost a parent/guardian in the past year and has at least one child under the age of 21. All applications will be read and considered for this gift. The chosen family will be notified before February 1st. 2026.
Name of Nominated Parent/Guardian
*
First Name
Last Name
Nominee's Email
*
example@example.com
Nominee's Phone Number
*
Nominee's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Family Information
Names and ages of each nominated family member (immediate family)
*
Are all nominated immediate family members citizens of the U.S.?
*
Yes
No
Please share the nominated family's story of loss:
*
Please share why this family should be granted this amazing opportunity:
*
Obituary of deceased parent.
*
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Thank you for nominating this family. We may be contacting you for more information.
Name of person filling in this application
*
First Name
Last Name
Relationship to Nominated Person:
*
Please Select
Self-Nomination
Family member
Friend
Other
Email Address
Phone Number
Please enter a valid phone number.
Submit
Should be Empty: