2025 Holiday switch-adapted item nomination form
This is a nomination form to apply for a gift of a switch adapted item for individuals in the Pacific Northwest area thru Emma’s Exceptional Equipment Exchange (EEEE). This is not a guarantee that the individual will be given a switch adapted item. Items will not be shipped and will need to be picked up either at the Holiday event on Dec 13th, 2025 in Parkland, WA, or afterwards from one of our designated pickup location, if chosen. Pickup locations are currently planned for Federal Way, Spokane, Portland, Wenatchee and Yakima. We will notify the parent and/ or nominating party if the individual is selected to receive a switch adapted item. There are a limited number of items and it is not first come first served. Our goal is to gift switch adapted items to individuals that would benefit from such item but could not otherwise afford one. If cost is not prohibitive for you, please reserve this opportunity for those who may not be able to afford such items.
Nominator's Name
Nominator's Email
Are you the Nominator AND the Parent/Caregiver?

About the individual

Name of exceptional individual that would benefit from a switch adapted item.
Address of Individual or their family
Have they been nominated for other switch giveaways, or received an item last year? (select all that apply)
Has this individual used or trialed switch adapted items before?
Do you already have a switch available to you?
Limitations we should know about:
Preference of item type – you can select more than one
Will the individual be able to attend a Sensory friendly Holiday gathering on December 13th, 2025 in Parkland, Washington to pick up the gifted switch item and participate in the event if they wish? Time and location will be shared with those selected.
If not within a reasonable distance or unable to travel to the Christmas party On Dec 13th in the Seattle / Tacoma area, which location is closest to you for you to pick up from, if chosen for a switch item.
Please note that we CAN NOT deliver or ship items. They must be picked up. Times for Portland and Yakima may be very limited.
I acknowledge that filling out this form does not guarantee the nominated individual will receive a switch adapted item. I also understand that this opportunity is being offered to help those who otherwise would not be able to afford a switch adapted item. Selection may be based on need. The switch adapted item can not be sold as per the rules of Emma's Exceptional Equipment Exchange.
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