UCCU Assist Nomination Form

UCCU Assist

Join us on our Mission to Help

Nominate someone you know for a UCCU Assist.

Your Information

Name(Required)

First Last

Phone(Required)

Email(Required)

City of Residence(Required)

What is your relationship to the nominee?

Potential Recipient of the UCCU Assist

Name(Required)

First Last

City of Residence of Nominee(Required)

Why does the nominee need a UCCU Assist?(Required)

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