If you are nominating a senior for a wish, please remember that all questions refer to the senior you are nominating. Please be as thorough as possible to ensure your application is considered.

Senior Contact Information
Title
First *
Middle name(s)
Last *
Birthdate *
E.g., 10/24/2021
Senior Address
Nominator Contact Information
Nominator Address
Wish Application
Please restrict your answer to 100 characters or less
Please be detailed in your response. 300 character minimum
Please be detailed in your response. 100 character minimum
Please be detailed in your response. 100 character minimum
Please be detailed in your response. 100 character minimum
This wish and/or my story will inspire others because... (100 character minimum)
Please be detailed in your response. 100 character minimum

Nominators: Please remember that all questions refer to the senior you are nominating.

Please be detailed in your response. 100 character minimum
Please specify what organizations you volunteered for and for how long. If you were a member of the military, please list branch and describe your service. Include your duties and list any battles or campaigns you were a part of as well as any medals or honors you received. Please be detailed in your response. 100 character minimum
Please consider accommodating for wheelchairs, oxygen, dementia care, etc. Please note: WOL tries to make every effort to accompany for cognitive and physical impairments when planning Wishes.

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By submitting this wish, I acknowledge that acceptance of this application by Wish of a Lifetime (WOL) does not constitute a commitment by WOL to fulfill my wish request. If WOL determines that this wish should enter the next stage of the wish process, a WOL representative will contact me for more information. I understand that this contact also does not constitute a commitment to grant my wish. Furthermore, I certify that I meet all qualifications for eligibility, and declare that all of the information given by me in this application is true to the best of my knowledge, and I agree to inform WOL in a timely manner should any information provided in this application change.