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Awaiting Transplant

Fill out the form below to submit your Story of Hope. If you would prefer, you can download this word document and email it to us at

Your Information
If you have a different way to refer to yourself, enter it here.
Transplant Information
Please tell us about your need for transplant.
List the organ(s), eye(s), and/or tissue(s) you hope to receive.
Your Story
The following questions are meant to help you focus on the most compelling parts of your story. From the information you provide, Donate Life Northwest will build a cohesive written piece that tells your Story of Hope. Please provide no more than 100 words per question.
Please upload a photo of you and your family if you wish.
One file only.
60 MB limit.
Allowed types: gif, jpg, jpeg, png.
Choose ONE that best describes your reason for submitting your story.
Terms & Conditions
By submitting personal stories to Donate Life Northwest, individuals agree to the following statements:
Submission Statement 1
1) I agree that by submitting this personal story and photographs (optional), I authorize Donate Life Northwest to review submitted materials and determine use for publicizing transplantation, donation and to promote the need for organ, eye and tissue donors. Donate Life Northwest will notify me (using the contact information I have provided in this form) in the event that my story and/or images will be used.
Submission Statement 2
2) By clicking "Submit", I understand that my story may be used in the media (TV, newspapers, magazines, radio, etc); online (website, social media, etc.), and more generally as part of Donate Life Northwest’s outreach and promotional purposes.