Survey - 2025 Children's Hospital Colorado Ambassador Nomination Form

Children's Hospital Colorado Ambassador Program Nomination Form Class of 2026-2027

Patients selected for the Ambassador Program display extraordinary strength and courage in the face of tremendous medical challenges. If selected, they share their personal stories at fundraising events and in marketing materials to inspire generosity and philanthropic support for Children's Colorado.

By sharing their personal experiences and healthcare journeys, patient ambassadors connect the impact of philanthropic giving to the hospital’s mission, encouraging community engagement and donations.

Please use the following form to submit a nomination for the 2026-2027 Children’s Colorado Ambassador Program. Only one person can be nominated per form, so please submit a new form for different nominations. Siblings can be nominated. Nominations will be accepted from April 1 to May 2, 2025.

After the nomination is reviewed, the patient and family will be contacted by a Foundation team member so they can learn more about the patient’s specific Children's Colorado journey. Patients/families can learn more about the Ambassador Program at that time.

If you have any questions, please reach out to ambassadors@childrenscoloradofoundation.org.

Thank you for taking the time to nominate an amazing patient!

Nomination Form

Please fill out about Nominee/Patient's information below

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Question - Required - Nominee/Patient's First Name:

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Question - Required - Nominee/Patient's Last Name:

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Question - Required - Nominee/Patient's Birth Date: (MM/DD/YYYY)

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Question - Required - Guardian's First Name:

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Question - Required - Guardian's Last Name:

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Question - Required - Guardian's Phone: (enter all 10 digits, numbers only)

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Question - Required - Guardian's Email Address:

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Question - Required - Nominee/Patient's Street Address:

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Question - Required - Nominee/Patient's City:

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Question - Required - Nominee/Patient's State:

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Question - Required - Nominee/Patient's Zipcode:

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Question - Required - Primary location for treatment:

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Question - Required - Dates of treatment? (beginning: MM/YYYY, ending: MM/YYYY, or ongoing)

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Question - Required - Why are you nominating this patient to be considered as a patient ambassador - what makes their story powerful and inspiring? Unless you are a parent or guardian, please do not provide details about diagnosis or treatment.

Question - Not Required - Please share a brief statement as to why this patient would be a wonderful ambassador. 01:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Please share a brief statement as to why this patient would be a wonderful ambassador. 02:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Please share a brief statement as to why this patient would be a wonderful ambassador. 03:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Please share a brief statement as to why this patient would be a wonderful ambassador. 04:

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Does the patient and/or family know about this nomination? Select "yes" if you are a guardian or patient submitting this nomination.

Your Information:

Please fill out your information below


*	First Name: Required
*	Last Name: Required
*	Email: Required
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Nomination Window: April 1 to May 2, 2025

Nominated patients/guardians will be contacted by a Children's Colorado Foundation team member to learn more about their story. Through a selection committee, no more than 25 patients will be selected for the 2026-2027 Patient Ambassador Class. Any nominated patient who is not selected as part of the Patient Ambassador class may still be contacted for additional information and may also be asked to participate in sharing their Children's Colorado journey through different channels.