Nominate a Family for Luminara Support
Share your or another family’s contact details and the kind of support that would help most.
Please read before submitting:
Do not submit medical records, therapy records, school records, government IDs, Social Security numbers, financial account details, payment-card numbers, passwords, or other sensitive documents.
Submitting this form does not guarantee selection or financial assistance.
Luminara Prep is not a nonprofit, and support contributions are not tax-deductible charitable donations.
Are you nominating yourself or another family?
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Myself / My family
Another family
Nominator Name or Organization
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First Name
Last Name
Nominator Email
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example@example.com
Nominee or Family’s First Name or Preferred Name
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Parent/Guardian/Caregiver Name
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First Name
Last Name
Parent/Guardian/Caregiver Email or Phone (optional)
Do you have permission for Luminara Prep to contact the parent/guardian/caregiver directly?
Yes, I have permission
City
State
Number and ages of children (optional)
What kind of support would help most?
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Learning resources
Sensory items
Educational experiences/outings
Family respite/getaway support
Other
Public Sharing Permission
If selected, Luminara may create a privacy-safe public need card. We will not publish full child names, addresses, schools, diagnoses, medical or therapy records, financial information, government IDs, or other sensitive information.
May Luminara create a privacy-safe public need card if this family is selected?
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Yes
No
Briefly tell us what support would make the biggest difference right now.
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May Luminara Prep contact you for more information if needed?
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Yes
No
If nominating someone else, I confirm I have permission to share their basic information or am only sharing non-sensitive information.
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I confirm
Submit Nomination
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