Operation Christmas Cheer
Veteran Nomination Form
Nominee Information
Full name
*
First Name
Last Name
Phone number
*
Format: (000) 000-0000.
Date of birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Branch of military service
Please Select
Army
Navy
Marine Corps
Air Force
Space Force
Coast Guard
Is the nominee currently enrolled in the VA health care system?
Please Select
Yes
No
Are you currently receiving home care services?
Please Select
Yes
No
If yes, what company are you working with?
If no, are you interested in receiving home care services?
Please Select
Yes
No
Do they have any food allergies or dietary restrictions?
What are their current needs and how we could best help them this Christmas?
Nominator Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Relationship to the veteran
*
I confirm that I have permission to provide the veteran’s information and understand that the program may contact the veteran or their authorized representative regarding this program.
I understand that Submitting a nomination does not guarantee assistance or selection for the Christmas program. Information submitted will be used only for purposes related to the Christmas program.
Submit Now!
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