nominate

Nomination Form

Section 1: Contact Information

Deserving Senior

Name

First

Last

Preferred Name/Nickname

Phone

Address

City

State

Zipcode

Date of Birth

Nominator(if applicable)

Name

First

Last

Preferred Name/Nickname

Phone

Address

City

State

Zipcode

Relationship to Senior Nominee

Section 2: Day by Design Information

Please be as specific as possible when answering the following questions. This can be a self nomination or nomination for a deserving senior.

What would your/their ideal Day by Design look like? Where would you/they go? What would you/they do?

What makes these activities and locations meaningful to you or your nominee?

Why are you/they unable to experience these activities and locations on your/their own?

Have you/they gone on a Day by Design with thinkJOY in the past or had a wish granted by any other wish-granting organizations?

Yes

Not sure

If yes, please explain with detail:

Section 3: Give a Gift

Think there is a gift that will lift a senior's spirits? Please share with us what you would like to see your nominee receive and why you believe this gift will bring them joy.

Section 4: Background information about the senior

Do you have any medical concerns that reflect a risk of safety for yourself or nominee?

What accommodations would be needed during the Day by Design outing?

*We will make every effort to make these kinds of accommodations.

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If you are human, leave this field blank.

Let's help plan a beautiful day—a Day by Design—and take action, together!

nominate

nominate

Section 1: Contact Information

Deserving Senior

Nominator(if applicable)

Section 2: Day by Design Information

Section 3: Give a Gift

Section 4: Background information about the senior

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