NWPPN Care Package Form | Abby's Hope Project

This form is subject to validation. Packages may take up to four weeks to ship. We reserve the right to refuse to fulfill your application if you appear suspicious of completing a fraudulent application form.

NWPPN Care Package Application Form

First Name of Recipient

Last Name of Recipeint

Recipeient's Age

Customizations, interests, any items to exclude, etc.

Address

Social Media Handles (used to verify legitimacy)

Gender

When were you diagnosed with PANDAS/PANS/AE

Submitting a photo of the recipient or family is not required. By uploading a photo, you give Abby's Hope Project permission to post it on our social media pages and website alongside your answers to the questions below unless anonymity is specified. This allows us to promote our program and share our impact.

Upload Photo

What does our mission mean to you?

As a care package recipent, what impact will AHP have on you or your family?

What advice would you give to other families or indivuals who are affected by PANDAS/PANS/AE? (This may be anonymously shared on social media)