Nominate a Child Form

Who is Eligible?

1. Child will be considered if he/she has a long term illness/disability or has suffered a life changing trauma.

2. Child is between the ages of 0 and 17 years old, if the nominee is 18 years old and still is in high school they can be considered as well.

3. Child is a Wisconsin resident.

4. Child’s family is in financial need. [Monies raised need to be used towards cost of day to day care, travel expenses (related to doctor visits or hospitalization), medical expenses, or medical/therapy equipment needs.]

How to Nominate?

If the child you wish to nominate falls within our eligibility requirements, please fill out the form to the right and our Board of Directors will review it and get back to as soon as possible.

We are looking for a brief description of the child’s situation, family, financial need or if there is something specific the child needs, and what kinds of fundraising efforts have already been done.

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Thank you!

Appreciate the daily miracles of life!

-Lailah Gifty Akita