Glynda's Gift Nomination Form

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Please complete the form below with your nominee's information.

Email *

Single Parent's Name (First and Last) *

How many children does this parent have? *

Does this parent have primary custody of their children? *

Yes

Nominee Address *

We will use this address to verify their eligibility and to contact them if they are selected to receive an award.

Nominee City, State, and ZIP *

Nominee Phone or Email *

We will only contact nominee if they have been selected to receive an award.

Why would you like to nominate this single parent to receive an award from Glynda's Gift? *

How would you hope the nominee would use the gift if they received it? *

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