Christmas Wish Nomination Form | United Way of Central Illinois

Your Information

First Name

Last Name

Mobile Number

Address

City

State/Province

Zip Code

Best time to contact you?

Nomination Information

If selected your nominee will be notified of your nomination

Who would you like to nominate? (First and Last Name)

Nominee Address

City

State/Province

Zip Code

Nominee Phone Number (including area code)

Tell us about the Good Deeds that the nominee has done or why this individual/family deserves to have a Christmas Wish fullfilled?

Tell us about the nominee's SPECIFIC need (Christmas Dinner for 4, haircut, school supplies for ##, etc...)

Additional Comments/Information

Best time to contact nominee?

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