By signing below, I authorize Sparkles of Life, Inc. and the Sparkles' Garden of Life Selection Committee to obtain information - written, oral, or other - from my physician and any law enforcement agency, consumer reporting agency, or other persons with knowledge of such information, bearing on my character, general reputation, personal characteristics, mode of living, criminal background and driving record. Sparkles of Life reserves the right to conduct this investigation at any time.
I am aware that my name, address, telephone number, and e-mail address will be distributed to the Sparkles of Life board after the grant has been awarded. I understand that only my contact information will be available to board members, and all other information contained in the application materials will remain confidential, reviewed only by members of the selection committee.
The information I have given is correct and you may verify the information listed if necessary. I understand that selection is at the discretion of the Sparkles' Garden of Life Selection Committee and will not seek compensation of any sort in regard to the decision of the final awardees or the selection process/criterion.
(Electronic signatures are acceptable.)