Glynda's Gift Nomination Form
Please complete the form below with your nominee's information.
Email address *
Single Parent's Name (First and Last) *
Your answer
How many children does this parent have? *
Does this parent have primary custody of their children? *
Nominee Address *
We will use this address to verify their eligibility and to contact them if they are selected to receive an award.
Your answer
Nominee City, State, and ZIP *
Your answer
Nominee Phone or Email *
We will only contact nominee if they have been selected to receive an award.
Your answer
Why would you like to nominate this single parent to receive an award from Glynda's Gift? *
Your answer
How would you hope the nominee would use the gift if they received it? *
Your answer
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