Family/Friend of a Patient Waiting for 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 info@donatelifenw.org. 

Your information
Transplant Information
Please tell us about your loved one's need for a transplant.
List the organ(s), eye(s), and/or tissue(s) your loved one hopes to receive.
i.e. mother, father, child, sibling, friend, etc.
Patient's Pronouns
If your loved one has a different way to refer to themselves, enter it here.
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.
20 MB limit.
Allowed types: gif, jpg, jpeg, png.
Provide a URL weblink to a video if you have one
Check ONE box that best describes your reason for submiting 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.
Story Submission Agreement