Language
English (US)
Español
WAIT LIST for 2023 Holiday Gift Assistance Application-Hebron, Andover, Marlborough, Columbia-
If you have questions email: hihsfoodpantry@gmail.com. Preference is given to income eligible families with children up through high school ( age 18 only if still in high school) from Hebron, Andover, Marlborough and Columbia then extended to others as supplies allow. SOME NOTES: First: Only ONE person from each residential address may apply for the program. (If their is a duplication of child from multiple applications we reserve the right impose limits. ) *** Second: You must have legal physical custody or guardianship of child(ren) and be able to show that upon request. ***Third: Not available to grandchildren at this time. *** Fourth: You may be asked to provide proof of residence and or income through a separate email if we do not have that infomation on file. ***
Applicant Information:
Must be a parent or have legal guardianship of the child(ren).
Name
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
MM-DD-YYYY
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (CELL PHONE PREFERRED)
*
Please enter a valid phone number.
Email
*
example@example.com
Employment Status of applicant:
*
Part-time
Full-time
Temporarily unemployed (less than 6 months)
Unemployed more than 6 months
Disabled
What is YOUR gross monthly income?
*
Includes wages, unemployment compensaion, child support, SS, SSi, SSDI, etc.
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.
Back
Next
Save
1st Adult OTHER than applicant.
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Relationship to you:
*
Type spouse, partner, parent, adult child, or explain.
Employment Status of other adult:
*
Part-time
Full-time
Temporarily unemployed (less than 6 months)
Unemployed more than 6 months
Disabled
What is their gross monthly income?
*
Includes wages, unemployment compensaion, child support, SS, SSi, SSDI, etc.
2nd Adult OTHER than applicant.
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Relationship to you:
*
Type spouse, partner, parent, adult child, or explain.
Employment Status of other adult :
*
Part-time
Full-time
Temporarily unemployed (less than 6 months)
Unemployed more than 6 months
Disabled
What is their gross monthly income?
*
Includes wages, unemployment compensaion, child support, SS, SSi, SSDI, etc.
3rd Adult OTHER than applicant.
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Relationship to you:
*
Type spouse, partner, parent, adult child, or explain.
Employment Status of other adult:
*
Part-time
Full-time
Temporarily unemployed (less than 6 months)
Unemployed more than 6 months
Disabled
What is their gross monthly income?
*
Includes wages, unemployment compensaion, child support, SS, SSi, SSDI, etc.
4th Adult OTHER than applicant.
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Relationship to you:
*
Type spouse, partner, parent, adult child, or explain.
Employment Status of other adult:
*
Part-time
Full-time
Temporarily unemployed (less than 6 months)
Unemployed more than 6 months
Disabled
What is their gross monthly income?
*
Includes wages, unemployment compensaion, child support, SS, SSi, SSDI, etc.
Back
Next
Save
Children in Home
(17 and Under)
Number of children 17 or younger in your home:
*
Type number
Fill out information for each child in your home
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 Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Age:
*
Gender Identification
*
Male
Female
Gender 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 Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Age:
*
Gender Identification
*
Male
Female
Gender 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 Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Age:
*
Gender Identification
*
Male
Female
Gender 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 Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Age:
*
Gender Identification
*
Male
Female
Gender 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 Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Age:
*
Gender Identification
*
Male
Female
Gender 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 Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Age:
*
Gender Identification
*
Male
Female
Gender 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.
*
Please Select
Yes
No
Back
Save
Submit Application
Next
Should be Empty: