COMPLETION OF THIS APPLICATION DOES NOT AUTOMATICALLY GUARANTEE THAT YOUR FAMILY WILL BE SELECTED.
This assistance program is designed to supplement your holiday needs and not be a complete substitution.
To ensure that as many families as possible get an opportunity to take advantage of the program, we must take into consideration the
number of times your family has received assistance in past years. However, this will not automatically disqualify your family from
receiving assistance again.
Applications are NOT selected on a first come, first served basis.
Please include any family hardships or notes we should be aware of on the back of this form.