Spotlight Submission Form
As a part of our social media awareness campaign, we are spotlighting young people who have died from fentanyl. We have found this to be a great way to honor the young lives lost while helping to raise awareness. We thank you for being willing to spotlight your child. For any questions, contact
[email protected]
Your Name
*
First Name
Last Name
Email
*
[email protected]
Relation to the Victim
*
Parent, Sibling, Friend, Family Member, Other
Victim's Name
First Name
Last Name
Age of victim
Date victim passed away
-
Month
-
Day
Year
Date
Please write a sentence or two about how they passed away (ie. specifics like Charlie buying what he thought was a Percocet online but was actually a fake pill).
Share some personal memories and tidbits about them- 3-4 sentences
Are you able to share if/why they were seeking to self medicate? (ie, were they stressed about something?) Were they aware of fentapills?
Who they've left behind (ie. sister, brother, cousin)
Images
Please upload 4-6 high resolution photos (1200 pixels) of the person that passed away below
File Upload
Browse Files
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of
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