This application is to request holiday assistance

Before starting this application please have the following ready:

  1. Photo ID
  2. Proof of all income
  3. Proof of YOUR address
  4. Must complete 2 hours of volunteering

By checking this box you agree that you fully inderstand application qualifications

Head of Household

Date of Birth:
Employeed
Veteran
Disabled

Groups living in household

Assistance

Have you received assitance here before? Yes No
Are you receiving assitance from other agencies? Yes No
Do you attend church? Yes No
Did you receive assistance for the summer food program? Yes No
If yes, Did you volunteer to complete your 1hr of service? Yes No

Income

Document Upload

Upload your photo ID:
Upload your SS Card:
Upload your proof of address: