The Spirit of Giving program supports LG Health employees and their families who are facing a serious or emergent need during the holiday season. All participants and their information will remain anonymous.
 
To apply for support, please complete and submit the following form by November 1, 2019.

Note: Please review the entire form before starting to ensure you have all of the necessary information. There is no 'save for later' option. If you exit before submitting the form, all information that was entered will be lost.

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* Employee Information


Employee First Name

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* Employee Last Name

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* Employee Number
*This number is located on the back of your badge below your name (first 6 digits).

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* Work Location

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* Department Name

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* Primary Email Address
*Please provide the email address you use most often. Email will be used as the primary form of communication.

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* Do you have access and regularly check your email?

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* Primary Phone Number
*Please include the area code.

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* Please indicate the type of phone number provided.

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* Briefly describe the serious or emergent need you are facing this holiday season.

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* Have you participated in the Spirit of Giving program in the past?

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Family Information


Please list the first name, age gender, and relationship to you of your immediate family members, including yourself. All participants in this program will remain anonymous. Only age and gender information will be shared.

*Immediate family indicates those family members/dependents who live with you and depend on your support.

Example - Joe, 14, M, son

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* Please add any additional immediate family members in the space below.
*Immediate family indicates those family members/dependents who live with you and depend on your support.


Wish List


Using the spaces below, please provide a list of items that each of your family members, including yourself, needs and/or wants this holiday season.


While completing your lists, please BE SPECIFIC and consider the following:

Clothes: what type (socks, PJ's, sweaters, hoodies, shorts, pants, jeans, coat, gloves, etc.), size, color preference, if sports related - favorite team(s).

Toys: list actual toy names, favorite TV shows or movies, games (if electronic, please include gaming system name), books, types of dolls, favorite activities and interests, sports (include favorite team(s)).

Household Needs: list actual items needed (toilet paper, diapers, towels, sheets, cleaning supplies, dishes, iron, etc.), and include size, color, brand, etc., if applicable.

Food: Where do you typically shop for groceries? Favorite types of food/restaurants?

Gift Cards: Be specific. What store(s) do you typically shop at (clothing, groceries, household items, gas, etc.). Favorite activities, restaurants, etc.

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* Employee/Self

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* Family Member 1

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* Family Member 2

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* Family Member 3

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* Family Member 4

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* Family Member 5

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* Family Member 6

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* Family Member 7

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* Please add any additional immediate family members and their wish list(s) in the space below.
*Immediate family indicates those family members/dependents who live with you and depend on your support.

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Additional Information


Please include any other information that may be helpful while purchasing gifts for you and your family
(i.e., things you do not want, allergies, etc.)

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* Do you have any pets?

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* What types of activities do you like to do as a family (i.e., movies, bowling, go out to eat, etc.)?
*Please provide information that would help someone purchase gift cards towards these types of activities (i.e., favorite restaurants, local theaters, etc.).

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* Do you use and/or rely on public transportation?
*Please provide information that would help someone purchase gift cards towards this need (i.e., bus, train, etc.).

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Transportation

The Spirit of Giving event will be held on Wednesday, December 11, 2019.

Please note, you are responsible to pick up and transport your gifts (a vehicle with storage space will be needed). Additional information, including instructions for gift pick up will be provided to you no later than December 2.


By checking the box below, you acknowledge your understanding of the transportation requirement for gift pickup.



To complete and submit this form, please click the Submit button below. A Spirit of Giving 
Family Coordinator will reach out to you with your specific family number, as well as additional
information no later than December 2. This Coordinator will be your resource throughout the process.

If you have any questions prior to hearing from your Coordinator, 
please email LG-SpiritOfGiving@pennmedicine.upenn.edu.

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