We believe that there is a Genie in everyone of us and love granting wishes to people that inspire others to do good. Now visualize someone that you know who is changing lives, making their family, community or world a better place. Someone who gives and never seems to ask for anything in return: a true community hero. Is this you? Someone you know?
Let us know if this wish is for you or another hero.
If you or your hero had one wish, what would it be?
$0-$5,000 Value:
$5,000-$10,000 Value:
$10,000 and above:
Now, please tell us a little bit about yourself.
*First Name:
*Last Name:
*City:
*State/Province:select state/provinceU.S and CanadaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
ZIP Code:
*Country:select countryUnited States of AmericaCanadaOther
E-mail address:
Phone number:
*Date of birth:select monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember select day12345678910111213141516171819202122232425262728293031 select year19801981198219831984198519861987198819891990199119921994199519961997199819992000200120022003200420052006200720082009
*Are you making a wish for yourself or another hero?
*If making a wish for someone else, what is your relationship to your nominee?
Where did you first hear about Experience Genie?
Either an e-mail address or phone number is required. Please note: Experience Genie may contact you for more information about you or your nominee.
Either an e-mail address or phone number is required.
Age: 25 and under 26-49 50+
*Select a category: Championing Children: Commitment to the welfare of young people Community Crusader: Creating solutions to a local problem or social issue Defending the Planet: Innovative efforts to preserve and protect the environment Medical Marvel: Dedication to the enhancement of human health Protecting the Powerless: Advancing the cause of human or equal rights Young Wonder: Outstanding achievement by a person 25 or under Other: Use this category if your hero's cause doesn't fit into one of those above
*In your own words, why do you or your nominee deserve recognition as a GENIE Hero and be granted a wish? Please describe in detail you or your nominee's specific accomplishment and what was involved in achieving it. Be sure to include the dates of the activities.(200 word maximum)
*How have you or your nominee's efforts made a difference for the better? Please describe their impact, potential impact and how they have inspired others. (100 word maximum)
*Is there a specific incident or turning point that motivated you or your nominee to take action? (100 word maximum)
Is there anything else that makes you or your nominee exceptional or unique? (100 word maximum)
How will being recognized as a GENIE Hero and being granted a wish further you or your nominee's cause? (50 word maximum)
If you would like to share any websites or online articles about your nominee's activities, you may enter up to 3 links here.
By submitting your nomination you agree that you have read and accept the legal disclosures