Nomination Application
*NOMINATE AN INDIVIDUAL WITH SPECIAL NEEDS/DISABILITY FOR A CHANCE TO RECEIVE A DISNEY WISH FROM PIXIE DUST WISHES.
*NOMINEE MUST LIVE IN PENNSYLVANIA IN THE FOLLOWING COUNTIES: CENTRE, BLAIR, CAMBRIA, CLEARFIELD, CLINTON, UNION, MIFFLIN, HUNTINGDON, PHILADELPHIA, DELAWARE, MONTGOMERY, AND BUCKS.
*NOMINATOR MUST WORK WITH THE INDIVIDUAL ON A PROFESSIONAL LEVEL ONLY.
Nominator's Name *
Your answer
Nominator's Email *
Your answer
Nominator's Phone Number *
Your answer
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