Thanksgiving Blessing Nomination Form

Help us share the spirit of gratitude this Thanksgiving!
Beacon of Hope for Mothers’ Inc. is providing Thanksgiving meal baskets and grocery gift cards to single mothers in need.

Thank you for helping us bring warmth and joy to a single mother.
Please fill out this form to nominate a mother

who could use extra support.

Your nomination will be kept confidential and reviewed

by our Holiday Assistance Committee.

1. Nominee Information (The mother being nominated)

Full name

Phone

Email

Address

Street Address

City

State

Country

Postal Code

Number of Children

Ages of Children

Preferred Languages (English, Spanish, Other)

2. Reason for Nomination

Please share briefly why you are nominating this mother and her family for Thanksgiving assistance:

3. Family Needs and Preferences

Any dietary restrictions or allergies?

No

Yes

If YES, please explain:

Preferred form of assistance

Thanksgiving Food Basket

Grocery Store Gift Card

Either

Does the family have access to a kitchen to prepare a meal?

Yes

No

4.Nominator Information

Nominator Name

Nominator Phone Number

Nominator Email

Would you like to remain anonymous?

Yes

No

5. Consent

I confirm that the information provided is true to the best of my knowledge.
I authorize Beacon of Hope for Mothers’ Inc. to contact the nominee directly or through me to coordinate assistance.

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