Glynda's Gift Nomination Form
Please complete the form below with your nominee's information.
Single Parent's Name (First and Last)
How many children does this parent have?
Does this parent have primary custody of their children?
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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