Gift Recipient Application

Anna’s Celebration of Life Foundation (ACOLF) was inspired by a young Anna Molloy, a little girl born with a rare genetic disorder who wanted to ensure that other children with special needs were afforded the joy of “celebrating their specialness” by providing them with life-enhancing gifts (equipment, tools, and technologies) needed to thrive. Did you read the guidelines?

Those We Help

Indiana children with special needs.

We help nearly 100 kids each year! With your help, we can continue to expand our reach and help even more children. When you support Anna’s Celebration of Life Foundation, you are helping a child in need.

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If you have a child who you believe needs assistance, please fill out the application below. Once we receive your application we will review it and get in touch with you.

Gift Application

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Parent Info
Child Info
Questions
Additional Info
Submit

First Name *

Name of individual submitting this application (i.e. parent/guardian)

Last Name *

I am applying as:

The parent or guardian

The therapist or other applying for a patient

Applying for myself

If applying as a therapist or on behalf of a patient

Please provide the details of the parent/guardian of the child you are applying for.

First Name *

Name of parent/guardian

Last Name *

Email *

Email of parent/guardian

Parent/Guardian Home Address *

Parent/Guardian Home Address

Street

Parent/Guardian Home Address

City

State/Province

Zip/Postal

Gift Recipient Guidelines *

I have read and agree to the gift recipient guidelines.

View Gift Recipient Guidelines here.

If you are human, leave this field blank.

Gift Recipient Application

Those We Help

Indiana children with special needs.

Apply Now

If applying as a therapist or on behalf of a patient

Ways to Give

About Us

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Resources

About ACOLF

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