Beds for Kids Nomination Form

Please use this form to nominate a child/children for the Seattle Police Department Beds for Kids program.

Date

MM slash DD slash YYYY

Name of Person Nominating Child/Children:(Required)

First Last

Nominator Phone Number:

Nominator Email:(Required)

Relationship to Child/Children:(Required)

Parent

Guardian

Social Worker

Teacher

School Counselor

Other

(check one or more)

Relationship to Child/Children:(Required)

If “Other” please use this field.

Number of Beds Needed (max 3):(Required)

Name of Child/Children:(Required)

Age of Child/Children:(Required)

Parent/Guardian Name:(Required)

First Last

Parent/Guardian Email:(Required)

Parent/Guardian Phone:

Does Parent/Guardian Need Interpretive Services?(Required)

No

Yes

Household Language:(Required)

City of Nominated Family:(Required)

Thank you!

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