Holiday Hope 2026 Food and Toy Application

Holiday Hope 2026 Holiday Help Application

Helping Low-Income Seniors 55+ who have custody and are raising their grandchildren, Low-Income Families, and Low-Income Single Parent Families. Serving Multnomah and Clark, WA Counties. Inner Clackamas and Washington Counties. (Columbia, Benton, Yamhill, Marion, Linn, Polk Counties) (Depending on Program Availability)
I have read the Application requirements and information page and will abide by all the rules listed*
Name*

First NameLast Name
Address*

Residing County

Street Address

CityState

Zip Code
Phone Number*
Phone Number
Email*
example@example.com - Make sure your email is correct as all notifications will be sent to your email address
Please select your living situation*

Low Income Senior 55+ that has custody of their grandchildren and raising them in their homeLow Income Family with children in their homeLow Income Single Parent with children in their home
Please list your children's ages and sex *
Agreement *
By submitting this application, I affirm that I am a Low Income Senior 55+ who has custody of my grandchildren who I am raising in my home. I am a Low Income Family with children in my home. I am a Low Income Single Parent with children in my home. The facts set forth in it are true and complete. I understand that if I am accepted to receive help I will be notified of what benefits I am to receive. Any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate refusal to receive help from Holiday Hope.
Select one*

AgreeDisagree
Reference: *
Holiday Hope Accepts References from:
1. Your Phyicians office
2. Your Churches Pastor
3. Your Childs School Principle
4. An Agency you are working with to help with services. Reference will be contacted to verify the Information given
Reference Name*

Reference First NameReference Last Name
Reference Address *

Reference Residing County

Reference Business Address

Reference CityReference State

Reference Postal Zip Code
Reference Phone Number*
Phone Number
Reference Email*
example@example.com -
Date*

MonthDayYear
Signing Agreement *
Important Notice About Your Application
Signing and submitting this application does not guarantee acceptance into the 2026 Holiday Hope program. All references will be checked, and families with the greatest level of need will be prioritized.

If you are accepted, Holiday Hope will send you an official email confirming your acceptance and providing the date your gift cards will be mailed.

Please ensure that your mailing address and email address are accurate and up to date.
Holiday Hope is not responsible for lost or stolen mail, and gift cards will not be replaced.
Signature
Should be Empty:

Holiday Hope 2026 Holiday Help Application