Facility Nomination Form

Important Nomination Information

Submitting a nomination does not guarantee that assistance will be provided. Pink Fam Foundation cannot assist every nursing home, assisted-living community, memory-care community, or skilled-nursing facility that is nominated. However, we will do our best to support as many eligible facilities and residents as possible with the donations and resources available.

Nominations may be reviewed based on factors including the facility’s identified needs, number of residents, availability of donated items, location, facility participation and approval, delivery requirements, ability to distribute items safely, and other program-related criteria established by Pink Fam Foundation.

Nomination forms must be completed fully and accurately. Incomplete nominations may not be processed. Duplicate nominations or forms containing false, misleading, unverifiable, or incomplete information may be denied or disqualified.

Pink Fam Foundation may contact the nominated facility to verify its information, participation, resident population, requested items, delivery requirements, and willingness to accept donations.

Please do not submit residents’ Social Security numbers, financial information, medical records, diagnoses, medication information, room numbers, photographs, or other unnecessary private or sensitive information.

Nominator Requirement

The nomination form must be completed and submitted by an adult who is at least 18 years old.

Nominations may be submitted by:

• A resident’s family member or authorized representative

• A facility employee or administrator

• A facility volunteer

• A community member familiar with the facility

• Another adult who has a legitimate connection to the facility

Submitting a nomination does not mean that the person submitting the form is authorized to make decisions on behalf of the facility or any individual resident.

Selection and Distribution

Nominations will be reviewed using the Foundation’s program guidelines and available resources. Selection decisions are made by Pink Fam Foundation and are final.

Submitting a nomination does not create a contract, entitlement, guarantee, or legal right for the nominator, facility, or any resident to receive assistance.

Selected facilities will be contacted using the phone number or email address provided on the nomination form or through the facility’s publicly available contact information. The facility is responsible for responding within the stated deadline and confirming that it is willing and able to participate.

All donations and deliveries must be approved by an authorized facility representative before items are delivered or distributed.

Facilities may be asked to confirm which items are permitted, needed, safe, and appropriate for their residents. Pink Fam Foundation may be unable to provide certain requested items because of facility policies, resident-safety requirements, limited inventory, or unavailable donations.

Assistance may include items such as:

• Blankets

• Non-slip socks

• Hygiene and personal-care items

• Picture frames or appropriate room decorations

• Small artificial plants

• Large-piece puzzles

• Coloring books and activity supplies

• Seasonal door decorations

• Other approved comfort or activity items

Unless otherwise approved by Pink Fam Foundation, assistance will be provided as donated goods or approved services only. Assistance will not be provided to nominators or residents as cash, gift cards, refunds, reimbursements, or cash equivalents.

Items received through this program are intended to benefit residents of the selected facility. Donated items may not be sold, exchanged, returned for cash, or used for commercial purposes.

If a selected facility declines participation, fails to respond, cannot accept the available items, or cannot coordinate an approved delivery, the items may be returned to inventory and provided to another selected facility.

Privacy Notice

Information submitted through the nomination form will be used to:

• Review and process the facility nomination

• Verify facility information and prevent duplicate or fraudulent nominations

• Contact the nominator or an authorized facility representative

• Determine the facility’s needs and ability to participate

• Coordinate the collection, delivery, and distribution of donated items

• Maintain appropriate nonprofit program and distribution records

• Prepare anonymous program reports and statistics

Nominator and facility information will not be sold.

Information may be shared with authorized Pink Fam Foundation directors, volunteers, service providers, donors, or community partners only when reasonably necessary to review the nomination, verify information, administer the program, coordinate donations or delivery, satisfy recordkeeping obligations, or comply with applicable law.

Please do not include private medical or personal information about any resident. If additional resident-related information is needed, Pink Fam Foundation will work directly with an authorized facility representative and follow the facility’s applicable privacy and consent procedures.

Residents’ names, photographs, stories, or identifying information will not be publicly shared for promotional purposes without separate and appropriate permission. Permission may be required from the resident, the resident’s authorized representative, and the facility.

Agreeing to photographs, testimonials, publicity, or social-media recognition is optional and will not affect whether a facility is selected for assistance.

Equal Opportunity

Pink Fam Foundation administers this program without unlawful discrimination based on race, color, national origin, religion, sex, disability, or any other status protected by applicable law.

Program restrictions based on the Foundation’s charitable purpose, geographic service area, type of facility, facility participation, identified needs, available resources, and ability to coordinate safe distribution may still apply.

Pink Fam Foundation directors, officers, employees, volunteers, donors, sponsors, and their family members will not receive preferential treatment. Any potential conflict of interest will be reviewed under the Foundation’s conflict-of-interest procedures.

Program Changes

Pink Fam Foundation reserves the right to modify, postpone, suspend, or cancel the Nursing Home and Assisted-Living Support Program when necessary because of limited funding, insufficient donations, inventory shortages, facility restrictions, delivery limitations, safety concerns, circumstances beyond the Foundation’s control, or other legitimate program needs.

Selected facilities are responsible for confirming that donated items comply with their policies and are safe, appropriate, and suitable for their residents.

Pink Fam Foundation may substitute requested items with comparable available items or adjust the quantity and type of assistance provided based on donations, inventory, facility approval, and resident needs.