Nominate A Single Mother

Please complete the form to nominate a single mother to receive a financial contribution this Christmas season:

* Indicates required field

Nominee's Name *

First

Last

Nominee's Cashapp (ex: $NYACG) *

Nominee's Phone Number *

Nominee's Email *

Nominee's Address *

Line 1

Line 2

City

State

Zip Code

Country

Number of children *

Please explain your reasons for nominating this mother: *

Your Name *

First

Last

Your Email *

Your Phone Number *

Submit