Youth Nomination Enrollment Application – Big Hearts Under The Sky

Youth Nomination

This nomination form is intended to provide basic information concerning a youth, 18 years or younger, being nominated for a Big Hearts under the Big Sky trip experience. As part of the evaluation and trip granting process, additional clarifying information or follow-up descriptions may be requested in addition to that being requested on this form.

Download Pdf : Youth Nomination Enrollment Application

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Section 1: Basic Nominee Information

Child’s Name of Nominee(s):

Nickname

Address

Address Line 1

City

State

Zip Code

Age

Phone

Gender

Male
Female

Section 2: Individual or Organization Making the Nomination

Organization's Name

Contact Name

Address

Address Line 1

City

State

Zip Code

Phone

Please describe the nature of the life-threatening illness the child has been diagnosed with.

Please describe the medical or physical challenges faced by the nominee that affect their safety, mobility or ability to participate in the requested trip experience if granted?

Does the nominating Individual/Organization have the capacity to offer any financial support for this trip? If so, please describe.

Has the Nominee received a donated adventure experience in the last three years; if so, please list them below.

Section 3: Desired Experience

What type of Montana-based outdoors adventure experience is desired/requested (e.g. fishing, hunting, camping, backcountry pack trip, other)?

Big Hearts under the Big Sky emphasizes service to families to strengthen and restore through shared experience the benefits of a trip.

Please list the family members by name, relation, gender and age that would likely attend if the trip is granted.

What physical challenges do any of the family members face and that should be considered if this trip were granted?

ALL likely granted

We try and accommodate ALL the family members in some form of the trip. On hunting trips there can be only one hunter, but when fishing, camping horseback riding, etc. family members may be included. What activities would the attending family members like to enjoy as part of the Big Hearts trip experience?

Section 4: Nominee Qualifications

Big Hearts under the Big Sky was established to provide therapeutic outdoor experiences to those who have provided extra-ordinary service to our country and to do so in a way that allows the immediate family to enjoy and share in the experience as fully possible. To qualify for the Big Hearts program, the child must be between 6 and 18 years of age at the time of nomination and must be a resident of the United States and must be diagnosed with a life-threatening illness. As part of the nomination review process, it may be asked to have a letter from the child’s physician affirming their fitness and ability to participate in the requested trip experience.

Why is this nominee a good candidate for a Big Hearts adventure trip experience?

In what ways will the nominee’s family benefit from the experience?

Will you be able to provide a letter from the child’s Physician that will address the fitness for the child to participate in the granted activity?