NOMINATE A WISH
Thank you for your interest in Fill Your Bucket List Foundation. We welcome nominations for potential wishes and require the following information in order to properly review each request. Please submit this form to nominate yourself or someone else.
Please note, priority is given to residents of North Carolina. Due to high demand, at this time, we are only able to serve residents of North Carolina, or patients who are receiving treatment in North Carolina. It would be our wish to serve everyone, but we are a small organization with limited resources and unfortunately it is simply not possible to meet the needs of all the inquiries we receive.
Completion of this form does not guarantee Fill Your Bucket List Foundation will grant the requested wish.
Email us at email@example.com if you have questions about submitting a nomination.
At this time we are unable to accommodate requests to travel outside the contiguous United States (including cruises). Additional requirements are detailed at the bottom of this form. By submitting this form you agree to the terms listed below.
Please submit the wish recipient's tax returns from the past two years. If the wish recipient does not file taxes, please provide documentation to show all income received (include disability, SSI, etc.). We will begin your wish review upon receipt of this financial documentation.
Email to: firstname.lastname@example.org
OR Mail to: Wish Nomination Committee, P.O. Box 806, Cary, NC 27512
The Fill Your Bucket List Foundation nominations committee will review each submission in the order it is received. We will contact the nominator if there are any questions or more information is needed. A representative will confirm receipt within two business days after receipt of all required materials.
Currently Fill Your Bucket List Foundation is not able to accommodate any travel outside the contiguous United States (including cruises).
Fill Your Bucket List Foundation Bylaws restrict payments for medical bills, other bills and certain material goods.
By submitting this form the nominator and potential wish recipient agree to allow Fill Your Bucket List Foundation staff, Board of Directors, and review committee members to have access to all information contained in this form as well as the contents of the supplemental information contained in the financial position documents.
By submitting this form the nominator and potential wish recipient agree all information contained in the submission is accurate and in no way falsified. The potential wish recipient agrees to provide supporting documentation to prove any information requested in this form.
Fill Your Bucket List Foundation is not responsible for loss of privacy or security of health and financial information by submitting this form.