Nomination Form | Viva Design Miniatures

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Name of Nominee*

Age*

City & State*

Does the nominee have an intellectual disability?*

Yes

No

Is there space in their home for an extra large dollhouse?*

Yes

No

Why do you think they would enjoy or benefit from receiving a dollhouse?*

Upload a Photo of the Nominee (OPTIONAL)

Name of Person Submitting Nomination*

Relationship to Nominee*

Self

Parent

Relative

Friend

Phone Number*

Email*

I confirm that the nominee meets the eligibility criteria.

I understand that submitting a nomination does not guarantee selection and that recipients are chosen at Viva Design Miniature's discretion.

I give permission for the information submitted to be used for selection purposes only.

Viva Design Miniatures

Lakeland, FL

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