This document appears to be a nomination form for a program called "S-ANTX FOR-SENIORS" that provides care and celebration for seniors during the Christmas season. It asks for information about the nominated person such as if they will be alone on Christmas, have experienced loss or health issues, their religious preferences, past traditions, address and phone number. Nominations must be submitted by November 30th.

1. -
NOMINATION FORM "S-ANTX FOR-SENIORS" -~
Accolade
" 0 M E C A. R £
Name of Nominee: -------------------------------------------------------
Nominated by: _
Will this person be spending Christmas alone? __
Have they recently suffered a loss or had a set-back in health? _
Will this person be open to visitors or hesitant? _
Would you ca II this person relig ious? _
Do you know of any special Christmas traditions this person has celebrated in the past?
What else should we know about this person to better serve them and celebrate with them
this Christmas season? --~------------------------------------------~----
What is the physical address of this person? '-- _
What is the phone number of this person? ~ _
May we tell them that yOlJ sent us? ~ _
ALL NOMINATIONS MUST BE TURNED IN BY NOVEMBER 30TH•