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PART 1 – PERSONAL INFORMATION

Home Address

Mailing Address (if different)

Contact Information

Military Information

Family Information

List all members currently living in the household (including yourself):











**IMPORTANT**

IF YOU ARE NOMINATING SOMEONE, PLEASE INCLUDE YOUR INFORMATION:

Contact Information

PART 2 – YOUR STORY (Mandatory)

PART 3 – FINANCIAL SITUATION

Savings and/or Retirement Accounts: (check all that apply)

Insurance: (Check all that apply)

If yes, how much and for whom?

Employer Information

By submitting this application and agreeing to the terms, you waive any rights to all materials provided to Gradient, and further acknowledge the requirement of executing such other additional releases and authorizations as required by Gradient, in their sole discretion, in conjunction with your application for participation in the ‘Gradient Gives Back’ program.

Your personal information will not be sold, or shared with unaffiliated third parties except as necessary to maintain and process information or when the law requires it.