Do you know someone who needs a hand-up? Nominate them today!

Please select: *

I am nominating myself.
I am nominating someone else. *

My Name *

First

Last

Email *

My phone number: *

My Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you a current Colorado resident? *

Yes
No

Nominee Name *

First

Last

Nominee Email *

Nominee phone number: *

Nominee Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is nominee a current Colorado resident? *

Yes
No

What category best fits the request for assistance? *

I am requesting assistance for an individual
I am requesting assistance for an individual who is the sole provider of their family
I am requesting assistance for multiple members of a family.

Is nominee a victim of the Marshall Fire? *

Yes
No

If a victim of the Marshall Fire, please briefly explain circumstances:

First, please provide us with some general information about the nominee:

What is the nominee's age? *

What is the nominee's current employment status? *

Please select the range that best fits the nominee's yearly household income: *

Do the nominee rent or own? *

Rent
Own
Live with someone else and do not pay any rent.

Now, help us get to know you or your nominee.

Provide some background on the situation leading up to the request for assistance: *

Please tell The Butterfly Foundation some background information about yourself or the person you are nominating for help.

How was this situation affected you or your nominee's life since? *

Please tell us what life has been like since this major situation occurred.

What are your or your nominee's goals for moving forward from this situation? *

Please describe how best The Butterfly Foundation could help you rise above your current hardship or tragedy. Provide specific details, assistance can be focused on spiritual healing, physical healing, or financial assistance.

Now, let's get some information on how you would like for The Butterfly Foundation to help.

Below are options for physical assistance. Please select the options that are most relevant to your current needs. *

The Butterfly Foundation can provide assistance in securing physical items needed to perform the activities of your daily life. This includes the areas and activities engaged in at home, work and school.

Please provide details for the physical assistance you are looking for: *

Below are options for financial assistance. Please select the options that are most relevant to your current needs. *

The Butterfly Foundation does not provide financial assistance for credit card debt, regular major medical bills, or major financial relief.

Please provide details for the financial assistance you are looking for: *

Please upload all copies of financial invoices which you are requesting financial assistance with.

Click or drag files to this area to upload. You can upload up to 5 files.

In order for your application to be considered complete, you will need to provide copies of invoices that you are requesting assistance with.

Below are options for emotional assistance. Please select the options that are most relevant to your current needs. *

The Butterfly Foundation supports all activities that have been proven to support emotional and mental health.

Please provide details for the emotional assistance you are looking for: *

Below are options for spiritual assistance. Please select the options that are most relevant to your current needs. *

Massage or acupuncture
Personal makeover
Personal / Family retreat support
Spiritual retreat connections or support
Assistance with a hobby that is healing for you.
Meditation or coping mechanism support

The Butterfly Foundation support activities that help to strengthen you spiritually and include teaching to help you expand on your self care routines.

Please provide details for the spiritual assistance you are looking for: *

Other - please describe in detail how The Butterfly Foundation could help you rise above your current hardship or tragedy *

Other Types of Assistance Received

In this section, please tell us about any other types of assistance you receive or have received in the last 3 years.

Please select all types of assistance you receive or have received in the last three years: *

Please provide details for all of the above assistance types selected. Include information such as specific amounts received, frequency, and date most recently received. *

Please list all Website / URL information for online fundraisers. *

Note: any assistance opportunities not disclosed at this time may lead to ineligibility for program assistance.

Personal References

To complete your application we ask you to provide contact information for a minimum of three (3) people to submit a personal reference on your behalf. References can be family, friends, coworkers, or any other individual who knows you personally and can speak to why this opportunity would provide a true transformation in your life. Applications without references will not be considered complete.

Full Name for Reference #1 *

First

Last

Email *

Does you reference know The Butterfly Foundation will be contacting them on your behalf for a reference? *

Full Name for Reference #2 *

First

Last

Email *

Does you reference know The Butterfly Foundation will be contacting them on your behalf for a reference? *

Full Name for Reference #3 *

First

Last

Email *

Does you reference know The Butterfly Foundation will be contacting them on your behalf for a reference? *

Last Questions

How did you hear about us? *

At The Butterfly Foundation, we believe in paying it forward. How would you pay it forward once your life has been transformed? *

Nominate

Do you or someone you care about need a hand-up?

First, please provide us with some general information about the nominee:

Now, help us get to know you or your nominee.

Now, let's get some information on how you would like for The Butterfly Foundation to help.

Other Types of Assistance Received

Personal References

Last Questions

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