Nomination Investigation Information

We are delighted to inform you that you have advanced to the next phase of the review process for our 2019 World of Children awards. At this time, our investigative team is requesting additional information about you and your organization.

Please complete the form below and upload any corresponding documentation no later than Monday, July 8, 2019. All submitted information will be held in confidence and used only in connection with evaluating your candidacy as a nominee for a 2019 World of Children Award.

If you have any questions, please contact Senior Manager of Programs and Operations Nicolle Quick at [email protected] or (949) 381-7670.

Nominee's Legal Name*
First Middle Last
Former Names and Date(s) Used
Please let us know if you have gone by any other names and when those names were used (if applicable).
Name 1 Date Used Name 2 Date Used
Preferred Email for Communication*
Current Registered Address for Your Organization*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Registered Address for Your Organization
If your organization's address has changed in the last two years, please list the previous address your organization was registered to.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nominee's Social Security Number, Citizen or National ID Number*
Nominee's Driver's License Number
(If Applicable)
Nominee's Passport Number
(If Applicable)
Please upload an electronic copy of documents that confirm your organization’s registration for charitable status.*
In the United States, this would be a copy of your organization’s letter of determination from the IRS.
Drop files here or
Please upload an electronic copy of the organization's most recent annual financial documents.*
Audited statements are preferred, if available.
Drop files here or
Disclosure
I hereby authorize Allied Universal, on behalf of World of Children, Inc., and its designated agents and representatives, to conduct a comprehensive review of my background causing an investigative consumer report to be generated. I understand that the scope of the investigative consumer report may include, but is not limited to the following areas: verification of social security or other national identifier number; credit reports; financial statements; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any court or criminal justice agency in any or all international, national, federal, provincial, state, county jurisdictions or those of any municipal or political subdivisions thereof; driving records, birth records, and any other public records. I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to Allied Universal or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. Allied Universal and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicants personal information, including, but not limited to, addresses, social security or other national identifier numbers, and dates of birth.
Acknowledgement of Disclosure*
- The information contained in this application is correct to the best of my knowledge.
Acknowledgement of Submission*
By typing your full legal name below, you confirm that the information submitted is accurate to the best of your knowledge, you authorize it to be used in connection with your application, and you specifically authorize Allied Universal to conduct the investigation described below in the Disclosure Section.
Date*
Date Format: MM slash DD slash YYYY

Nomination Investigation Information

Disclosure

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