EmailMe Form - The Shoes in Boots Project

In this section, please provide information about the nominee (2nd grade girl).

Nominee's Name *

First Last

Nominee's Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Nominee's Phone # *

### - ### - ####

Name of Nominee's School *

Address of Nominee's School *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Name of Contact at Nominee's School (e.g., School Social Worker) *

Name of Nominee's Church

Address of Nominee's Church

Street Address City State / Province / Region Postal / Zip Code Country / Region

Name of Pastor at Nominee's Church

Nominee's Shoe Size *

Name of Nominee's Parent/Guardian *

First Last

E-mail Address of Nominee's Parent/Guardian

In this section, please provide your (the nominator) information.

Nominator's Name *

First Last

Nominator's Phone # *

### - ### - ####

Nominator's E-mail Address *

Confirm

Nominator's Relationship to Nominee *

Briefly describe why nominee is deserving of a new pair of shoes or boots. *