New Family Registration Pictured above are the 2013-2015 recipient children and families. Recipient Application If you know of a family in need of our services, please take the time to review below and fill out all of the information requested. We will review as soon as possible and reach out to you with any further questions. Thank you for applying! Name of the individual nominating the children* First Last Email of the individual nominating the children* Phone of the individual nominating the children*How many years ago did the family lose their loved one?*0-12 Months1-3 Years3-5 YearsAddress of Recipient Children/Family* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ** Please note, this is the address of the recipient children, not your own. How are you related to the children for whom you are applying?*I am a related family memberI am a friend of the parent/childrenI am their parentDoes the family have an income currently less than $75,000 a year?*YesNoIs the family willing to assist in running the event for (2) years after receiving funding?*YesNoWhat are the names and ages of the recipient children*Please complete a brief description of the lost loved one including the following information: Nature of the loss, background and age of the lost loved one, any information on their character or highlights of their life that you would like to share*
