Holiday Hope 2026 Application Form
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
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Please Select
YES
NO
Do you have an application for services with any other agency for assistance?
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Please Select
YES
NO
Please list the agencies you have applied to for services and what services you applied for.
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Name
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First Name
Last Name
Address
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Residing County
Street Address
City
State
Zip Code
Phone Number
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Phone Number
Format: (000) 000-0000.
Email
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example@example.com - Make sure your email is correct as all notifications will be sent to your email address
Please select your living situation
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Low Income Senior 55+ that has custody of their grandchildren and raising them in their home
Low Income Family with children in their home
Low Income Single Parent with children in their home
Please list your children's ages
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Agreement
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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
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Agree
Disagree
Reference:
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Holiday Hope Accepts References from: 1. Your Physician's office 2. Your Church's Pastor 3. Your Child's School Principal 4. A representative from an agency you are working with to help with services.
Reference will be contacted to verify the Information given
Reference Name
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Reference First Name
Reference Last Name
Reference Address
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Reference Residing County
Reference Business Address
Reference City
Reference State
Reference Postal Zip Code
Reference Phone Number
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Phone Number
Format: (000) 000-0000.
Reference Email
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example@example.com -
Date
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Month
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Day
Year
Date Picker Icon
Signing Agreement
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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.
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