Request A Twilight Wish

REQUEST A WISH APPLICATION

Requirements and Restrictions*

I have read and agree to the Requirements and Restrictions

1: Twilight Wish Nominee Information

Wish Nominee Name*

First Last

Birth Date*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County*

Phone Number*

If you only have one phone number, please simply type "N/A" in the empty field.

Home Cell

Email*

Annual Household Income*

(estimated; include income from all sources)

Number of people living in the household*

Please enter a number from 0 to 10.

Wish Description*

2. Wish Nominator Information

Are you nominating yourself of someone else?*

Myself
Someone else

Wish Nominator Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number*

If you only have one phone number, please simply type "N/A" in the empty field.

Home Cell

Email*

Relationship to Nominee*

Does the nominee know you have submitted this wish?*

3. Importance of Your Twilight Wish

Please explain in detail why this Twilight Wish is so meaningful and special to the recipient and what prompted the wish.*

4. Personal History

Is the nominee a Veteran?*

Yes
No

If yes, please list what branch the nominee served in and details of his or her service.*

Past community involvement or volunteer service:*

Other information you feel is important:

How did you hear about Twilight Wish Foundation?*

Other*

5. Certification

By signing below, I acknowledge that the acceptance of this application form by Twilight Wish Foundation (TWF) does not constitute an agreement by TWF to fulfill my wish request. If TWF may be able to fulfill the wish request described above, a TWF representative will contact me.

Furthermore, I certify that the wish recipient meets all eligibility criteria established by TWF and I have read the wish requirements and restrictions. I declare that all of the information given by me in this application is true and complete to my knowledge. I agree to inform TWF in a timely manner if any information in this form changes.

Signature*

Comments

This field is for validation purposes and should be left unchanged.

Covid-19 Policy

How Can I Request A Twilight Wish And Who Qualifies To Receive One?

Twilight Wish Recipient Requirements

How Does Twilight Wish Determine If Your Wish Can Be Granted?

Twilight Wish Restrictions