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Your Information (Referrer):
Full Name:
Contact Number:
Email Address:
Relationship to Nominee:
Nominee’s Information:
Full Name:
Contact Number:
Email Address:
Preferred Contact Method (Phone/Email)
Phone
Email
Why do you believe this person needs a car?:
Current Transportation Situation:
Does the nominee currently own a car?
No
Yes
If yes, what is the condition of their current car?:
How would access to a reliable vehicle improve their life?:
Nominee’s Story:
Briefly describe the nominee’s situation, challenges, and why they would benefit from receiving a donated car.
Acknowledgment:
I confirm that I have permission to share this nominee’s information and story.
I understand that this recommendation does not guarantee that the nominee will receive a car.
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