We Choose Happy - Nominate Someone

Your Information

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Recipient First & Last Name

Recipient Age

What is the recipient's disability and/or medical condition?

Has the recipient ever recieved a "wish" from a different organization?

Yes

If you chose yes to received a wish please give detail.

Is the recipient currently living with the disability or medical condition?

Yes

No, the recipient has recovered from the disability or medical condition

Does the recipient and/or family know you are nominating them?

Yes

Please tell us the story of why you are nominating this recipient?

What in your opinion would make this recipient the happiest?

Is there a specific "happy" you are requesting for this recipient?

Recipient's Favorite Color

Recipient's Favorite City

Recipient's Favorite Sports Team

Recipient's Favorite Celebrity

Recipient's Favorite Things To Do

How did you hear about We Choose Happy?

Please add any additional information here.