Little Light of Mine Beneficiary Application

Little Light of Mine will be accepting applications for next year’s beneficiary until January 15th. Little Light of Mine has made it their goal to raise money at an event each year with a child as the primary beneficiary.

Child's Name

Child's Age

Parent/Guardian Name(s)

Parent/Guardian Phone #

Parent/Guardian Email Address

Name of Nominating Adult

Relationship to Child

Nominating Adult Phone #

Nominating Adult Email Address

Please describe any health issues or other difficulties that the child is currently enduring:

Please describe any special needs that the child needs to improve care or quality of life:

Please describe the financial need of this child:

Please describe in detail why you are nominating this child and give any other details you feel would help this child to be chosen as beneficiary:

If this child is chosen, how will you help support the annual event in order to ensure its success?

7 + 7 =