TEEN NOMINATION Nominator's Name * First Name Last Name Nominator's Phone # * (###) ### #### Nominator's Email * Nominator's Relation to Teen * Teen's Name * First Name Last Name Teen's Phone # (If teen doesn't have a phone, case worker or parent #) * (###) ### #### Teen's Email * Teen's Age * Teen's Grade in School * Teen's Current School * Does this teen have a valid driver's license? * Yes No Teen's Place of Work/Job * Foster Agency * DCCCA Eckerd KVC TFI St. Francis Restoration Family Services Ember Hope Youth Horizons Other/Adoption/Kinship Why do you believe this teen is deserving of this car? * How would this car benefit this teen's life? * What are some positive characteristics and strengths that this teen possesses? * Describe the teen's goals and aspirations: * Additional Reference Name * First Name Last Name Reference Phone * (###) ### #### Reference Email * Would the teen be available for an in-person interview? * Yes No Thank you!
