Car Donation Nominations | Lansing and Waverly, MI

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We've received your nomination.

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Relationship This is required

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Monthly Income

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Place of employment (if applicable) This is required

Employment Information

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Statement of need

Please explain your situation and why you need a car: This should explain what challenges you have faced in your life and any difficulties you are experiencing such as medical, employment, etc. (Attach additional page if needed)

I certify that:

I am a resident of Michigan
I am willing to share my story with the media
I am willing to provide any needed verifications to validate my need for this car
I have and will provide proof of a valid, current Michigan driver’s license

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Additional Information

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How would a car improve the quality of life for you and your family? (Attach additional page if needed)

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I certify that:

I have a clean DMV record
I have not been convicted of a violent crime, or felony
I am able to be insured and will insure the vehicle before taking possession of it
I will sign release forms for all media and liability

I certify that the information in this application is true to the best of my knowledge.

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