HIHS Thanksgiving Assistance Request

Deadline to Apply is November 19th

Thanksgiving Dinner assistance is available to income eligible individuals and families who are residents of Hebron/Amston and any family with a student in the RHAM School District.

Families will recieve a meat (turkey or roasting chicken depending on what is available), fresh sides which may include white potatoes, sweet potatoes, carrots, onions, winter squash, and apples. Other sides such as stuffing, gravy and dessert may also be provided depending on availability.

**Please note that families should only sign up for assitance in ONE town and we reserve the right to verify with other towns to avoid duplicaiton.**

**License or other photo ID will be required at pick up. Date/time to be determined. **

Sign up will remain open until supplies run out.

Thanksgiving Dinner Assistance Request Form

Full Name*

Address (include street number)*

Zipcode*

Families must meet the following GROSS income limits to receive assistance. Please select your Gross income level.*

1 person Gross Income at / below: $46,9502 people Gross Income at / below: $63,4503 people Gross Income at / below: $79,9504 people Gross Income at / below: $96,4505 people Gross Income at / below: $112,9506 people Gross Income at / below: $129,4507 people Gross Income at / below: $145,9508 people Gross Income at / below: $162,450Other

E-mail*

Cell Phone*

text messaging may be utilized

Number of people that live in your household. Do not include guests. *

I agree to only request help from ONE town or organization.*

yes

I acknowledge that my information may be verified with neighboring towns to avoid duplication of assistance.*

yes

First and last name of an alternate pick up person.

If you would like to share any thoughts or comments, or dietary requests with us please do so here.

Hebron Interfaith Human Services-Community Food Pantry