Future Innovators Fund Nomination Form

Please fill out this form to nominate a Student Recipient for a Parallax hardware gift. Nominations will be reviewed and gifts awarded monthly based on the availability of donated funds and the anticipated benefit to the recipients as described in the applications. Nominators will be contacted by email as to the outcome of their requests.

Future Innovator Fund Nomination

Your Name*
First Last
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Email*
Enter Email Confirm Email
Your Phone*
Recipient Student's First Name ONLY*
First name ONLY
Recipient Student's Grade*
Middle through high school, grades 5 - 12
Please enter a number from 5 to 12.
Relation to Recipient Student*
- Family member
- Teacher
- Academic advisor
- Club leader
- Mentor
- Neighbor/Friend
Hardware gift items requested*
List Parallax hardware items totaling from $25 to $300 total; please include Parallax stock code and price.
Why have you chosen this student and this hardware?*
Tell why you feel this young person is ready for, and how they would benefit from, the specific items you would like to give to them.
Consent*
I understand that this is a nomination and not all students nominated will be selected to receive hardware gifts.

I understand that if my nominated student is selected to receive a gift, I will be contacted to supply a US Domestic shipping address for the student.

I consent for my name and contact information to be included with any gift shipped to the student; the gift will not be anonymous.

I consent to have my first name, last initial, and quotes from my form entries regarding hardware selection and its anticipated benefits to the student used on this website and in Parallax social media.
I have read, understand, and agree to the terms above.

Future Innovators Fund Nomination Form

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