Beneficiary Nomination Form
Please fill the form below accurately and with as much detail as possible! Thank you!
Nominated Person
*
How old is the nominee?
*
Does the nominee (or family of minor) know they are being nominated?
*
Is the nominee a Trussville resident?
*
To your knowledge, has the nominee worked with other nonprofit organizations?
*
E-mail (or email for parent/guardian of minor)
*
Phone Number (or phone number of parent/guardian of minor)
*
-
Area code
Phone Number
Nominator:
Person submitting the nomination
Full Name
*
First Name
Last Name
Relation to Nominee
*
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Nominee Information
Please indicate details about your nomination & how this event could directly impact the nominee’s life.
Describe
*
Submit
Should be Empty: