Dream REQUESTOR Name
QLS Home Name
Dream NOMINEE Name
Resident T-Shirt Size Resident T-Shirt SizeSmallMediumLargeX-LargeXX-LargeXXX-Large
Is the resident aware of the request? Is the resident aware of the request? Yes No
Can the resident express this dream? Can the resident express this dream? Yes No
Please Give a Brief Description of the Dream Request
List any physical limitations or special needs
By filling out this form and writing your name below, I acknowledge that the acceptance by Don’t Stop Dreamin’ (DSD) of this application form does not constitute an agreement by DSD to fulfill my dream request. If DSD may be able to fulfill the dream request described above, a DSD representative will contact me. Furthermore, I certify that the dream recipient is a current resident of a Quality Life Services home and declare that all of the information given by me in this application is true and complete to the best of my knowledge and I agree to inform DSD in a timely manner if any information in this form changes. I agree that any photos taken of the resident can be used for promotional purposes on the DSD website and other media venues.
Qualifying Dream Recipient Requirements:
Restrictions on Types of Dreams:Don’t Stop Dreamin’ grants qualifying dreams as funding and resources are available. Don’t Stop Dreamin’ reserves the right to deny requests for any purpose in conflict with the mission of Don’t Stop Dreamin’. Don’t Stop Dreamin’ will deny the following types of dreams:
Don’t Stop Dreamin’ Dream Granting Committee Process:Dream recipients and requests are qualified by Board of Directors decisions. Applications must be completed in full.
Thank you for taking the time to complete this dream application on behalf of yourself or another
Service or In Kind Trade
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