Please complete the information below to the best of your ability. There are no “wrong answers.” If you need assistance in completing the nomination form, please contact Fresh New Start at (850) 583-0085. Required fields must be completed in order to submit the form.
Home Work Mobile
Mailing Address 1 (required)
Mailing Address 2
Relationship to Nominee (required)
How did you hear about FNS? (required)
Please provide a brief narrative about the nominee and the journey that resulted in her widowhood. Also include what has led you to make this nomination. (required)
Approximate Age at Spouse's Death
Number of Children
If yes, where?
Type of Cancer
Duration of Illness (Diagnosis to Passing)
Date of Spouse's Death (required)
Web Link to Obituary
By checking this box, the nominator understands all information above to be accurate, and also understands this submission in no way constitutes the awarding of a Renewal Trip by Fresh New Start. Nominator has also read the minimum requirements, found here, the nominee must meet for eligibility, and believes the woman nominated meets the criteria contained therein. This form is merely the first step in the nomination process.