Honoring Phil Tripodi's love of helping children

Eligibility & Referral

Eligibility

To be eligible, a child must be under the age of 18 at the time of referral and have lost a parent to the disease of addiction. We accept referrals from Parents or Legal Guardian, Teachers, Healthcare Professionals, Family Members & Members of the Community.

Requests

A Moment to Smile regrets that it may not have the necessary resources to grant the requests of all who apply. The Board of Directors  reserves the right to grant or deny a SMILE NOMINATION request.  We ask that the request be for something the child has expressed a desire for or a need that the caregiver is having difficulty providing.  All requests must be reasonable, obtainable & age appropriate.

Forms

Please download, complete and return the Smile Nomination Form.  Completion of the Smile Nomination Form does not automatically qualify the referred child to have their request filled.  A Moment To Smile regrets that our volunteers are not able to grant all requests.  This inquiry form is the first step to receiving a request.  It is not a confirmation of eligibility for a request. Your information will be forwarded and you will be contacted by a team member. 

The Smile Nomination Form & Photo/Video Use Release Form

Please complete the Smile Nomination form if you are referring a child for consideration.  Please complete the Photo/Video Release Form if you agree to let us use pictures of you and/or your child on our website or other media outlets.

The Smile Nomination Form (pdf)

Download

Photo Release Form (pdf)

Download