HIHS Holiday Assistance Form

2025 Holiday Gift Assistance Application-For Hebron/Amston and RHAM Families.

If you have questions email: hihsfoodpantry@gmail.com. Preference is given to income eligible families with children under 18 yrs (up to high school senior) from Hebron & Amston and students of the RHAM School District. APPLICATIONS DUE BY: NOV 21st.
Program Notes/Requirements:

1. Applicant must be the parent or legal guardain of the children included in the application and ALL adults and children must live or go to school in Hebron, Andover or Marlborough, CT.

2. Documentation may be required by separate email or appointment: Photo ID of applicant, Proof of Residence (with applicant's name and address) must be either a current utility bill, car insurance, property tax bill. Also required will be a birth certificate for each child or guradinaship documentation.

3. Each child will receive one to two gifts as long as there are donors able to fill the requests. No electronics or video games.
Applicant Information:

Must be a parent or have legal guardianship of the child(ren).
Name

First NameLast Name
Date of Birth*

MonthDayYear
MM-DD-YYYY
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (CELL PHONE PREFERRED)*
Please enter a valid phone number.
Email*
example@example.com
Other Adults in Home

NOT including yourself
Number of OTHER ADULTS (18+) living in your household? DO NOT INCLUDE YOURSELF*
Enter a number. IF none please put the number 0.
What is the gross monthly income of your HOUSEHOLD (include income of ALL working family members 18 years and up) ? We follow TEFAP income guidelines.*
Includes wages, unemployment compensaion, child support, SS, SSi, SSDI, etc.
Children in Home

(infant to senior year high school)
Number of children 17 or younger in your home:*
Type number
Fill out information for each child in your home. Give as much detail as possible.

Please share with us ideas of your child's interests, hobbies, or needs. For teens if gift cards are requested please indicate stores preferred. Please note specific requests cannot be guaranteed as all gifts are donated. Give as much detail as possible including clothing sizes if appropriate. Please note gifts are donated by members of our community and we ask that gift ideas be between $25- $50.
First Child: Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age:*
Gender Identification*

MaleFemaleGender Neutral
My child LIKES / WANTS :
Please give examples/ ideas of what your child likes/ wants. Provide as much detail as possible. Please note NO Electronics or gaming systems will be granted.
My child NEEDS:
Please provide clothing sizes, color preferences, and where you typically shop.
2nd Child: Name

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age:*
Gender Identification*

MaleFemaleGender Neutral
My child LIKES / WANTS :
Please give examples/ ideas of what your child likes/ wants. Provide as much detail as possible. Please note NO Electronics or gaming systems will be granted.
My child NEEDS:
Please provide clothing sizes, color preferences, and where you typically shop.
3rd Child: Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age:*
Gender Identification*

MaleFemaleGender Neutral
My child LIKES / WANTS :
Please give examples/ ideas of what your child likes/ wants. Provide as much detail as possible. Please note NO Electronics or gaming systems will be granted.
My child NEEDS:
Please provide clothing sizes, color preferences, and where you typically shop.
4th Child: Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age:*
Gender Identification*

MaleFemaleGender Neutral
My child LIKES / WANTS :
Please give examples/ ideas of what your child likes/ wants. Provide as much detail as possible. Please note NO Electronics or gaming systems will be granted.
My child NEEDS:
Please provide clothing sizes, color preferences, and where you typically shop.
5th Child: Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age:*
Gender Identification*

MaleFemaleGender Neutral
My child LIKES / WANTS :
Please give examples/ ideas of what your child likes/ wants. Provide as much detail as possible. Please note NO Electronics or gaming systems will be granted.
My child NEEDS:
Please provide clothing sizes, color preferences, and where you typically shop.
6th Child: Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age:*
Gender Identification*

MaleFemaleGender Neutral
My child LIKES / WANTS :
Please give examples/ ideas of what your child likes/ wants. Provide as much detail as possible. Please note NO Electronics or gaming systems will be granted.
My child NEEDS:
Please provide clothing sizes, color preferences, and where you typically shop.
I agree to only request assistance from ONE agency. I understand that gift requests cannot be guaranteed as all gifts are donated by community members.*

2025 Holiday Gift Assistance Application-For Hebron/Amston and RHAM Families.

Applicant Information:

Other Adults in Home

Children in Home

Fill out information for each child in your home. Give as much detail as possible.