Applicant Information Applicant Full Name Applicant DOB Applicant Mailing Address Applicant's Favorite Hobbies Any Triggers? YES NO Describe Triggers Is Applicant's Household in need groceries, utilities assistance, etc? YES NO Does Applicant Have 2+ Friends they socialize with regularly? YES NO Tell us a little more about the Applicant Parent or Guardian Information Parent / Guardian Full Name Parent / Guardian Phone Parent / Guardian Email Parent / Guardian Mailing Address Language Fluent In? Type of Disability? Date of Disability? If the applicant is selected will he or she and guardian be able to participate in fundraising and volunteering? YES NO Send
