EmailMeForm
Marion Toyota Project CAR Nomination
Please be as detailed as possible. Required information is marked with a star but all fields are here for a reason and we encourage you to provide all information that applies. You will be able to save form at bottom of page and come back to finish if needed.
Before nominating someone,
click here to read all PROJECT CAR TERMS & CONDITIONS.
Your First Name
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Your Last Name
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Your Address
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City
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State
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ZIP Code
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Main Contact Number
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List phone number at which you may be reached on a regular basis.
Confirm Phone Number
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Email Address
Valid email address required for online nomination.
Confirm Email Address
What time(s) of day may we reach you at this phone number?
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Please select
Day
Evening
Anytime
How did you learn about Project CAR?
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Your Nominee's First Name
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Middle Name or Initial
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Nominee's Last Name
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Nominee's Street Address
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Address Line 2 (such as PO Box, Bldg or Unit Number, etc.)
City
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State
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ZIP Code
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County of Residence
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Main Contact Number
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List phone number at which Nominee may
be reached on regular basis.
Confirm Phone Number
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Email Address
Nominee's email address if at all possible.
Confirm Email Address
What time(s) of day may we reach them at this phone number?
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Please select
Day
Evening
Anytime
How Long at this Address?
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Please choose type of residence:
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Please select
Owns
Rents
Lives in residence of friend or family member
Nominee's Age
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Give approximate age if exact unknown
Are they currently employed?
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Please select
YES
NO
ON LEAVE
RETIRED
STATUS UNKNOWN
If employed, where? If not, do you have knowledge of their recent work history or situation?
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Note: We will not contact their employer without their knowledge.
Please share how you know the Nominee:
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Do they have a valid Driver's License?
Yes
No
Unknown
Do they currently have access to a vehicle?
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Please select
Yes they own a car
Yes there is a household car
Yes they can borrow a car when needed
No they don't have regular access to car
If they don't have access to a vehicle, how do they currently get to and from places in daily life?
If they do have access to a car, please describe any problems or concerns with the vehicle:
Please share why you believe your Nominee is deserving of this opportunity and how it would make a difference in their life. Please describe in as much detail as possible.
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Application Requirement
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Please select
Yes, definitely
Yes, probably
Not sure
If we chose you and your Nominee to proceed in a face-to-face interview, would your Nominee agree to fill out an application including but not limited to address, driver's license, SSN, and other information, and be able to provide two references in addition to your recommendation?
Ability to Cover Necessary Costs
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Please select
Yes, can pay fees & insurance
Yes, with help from friend or family
Don't know
No, probably not
If your Nominee is selected to purchase a Project Car vehicle for $1, to the best of your knowledge could they also cover expense of full year of car insurance plus initial estimated license/title fees of $196?
Before you learned about Project CAR, were you already aware of Marion Toyota?
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Were you already aware of Marion Collision Center?
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