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2024 - 2025 LifeChanger of the Year Certificate Request
Please fill out this form to request a physical, mailed LifeChanger of the Year certificate for a current nominee. Any questions? Feel free to get in touch
here
.
*
1.
Please choose the statement that best applies:
(Required.)
I am a LifeChanger nominee requesting my own certificate
I am an administrator/district employee requesting my nominee's certificate
Other (please specify)
2.
If you are requesting a certificate on behalf of a nominee, please leave their name here:
*
3.
What is your full name?
(Required.)
4.
If you have any edits to the name on the original PDF certificate, please put them below.
*
5.
Please enter the address you'd like us to use for mailing. (Note: for nominees requesting personal certificates, we highly recommend using a personal address to prevent the certificate from getting lost.)
(Required.)
Address 1
Address 2
City
State
Zip Code
*
6.
What type of address is this?
(Required.)
School/district address
Personal address
Other (please specify)
