Back to School Outfit

Colchester Youth and Social Services

Back To School and Looking Cool
Colchester Youth and Social Services is organizing Back To School outfits and supplies donated by Local Residents. Clothing items are not guranteed due to the program being donation based but we will try our best to accomodate any requests/needs.

To qualify,
- You must be a resident of Colchester
- your household must meet the income requirements or be eligible for other social service programs such as SNAP, Free or Reduced lunch, TANF
- Have extenuating circumstances.
Deadline to submit this form is Friday August 1st

Pick up: We will call you when your request for your entire household is fulfilled to arrange a pick up. Pick-up should be around mid-August depending on donation availability.

Any questions on eligibility or the program can be directed to the Youth and Social Services office 860-537-7255.
Parents Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My household receives the following programs: (Select all that apply)
Extenuating Circumstances: (If applicable based on selection above)

Students Information

Rows	First Name	Last Name	Gender Identification	DOB	Grade for 2024/2025	Name of School attending
Student 1
Student 2
Student 3
Student 4

Student Clothing Requests: Please include as much details as possible. If size not listed please make note in size notes column ( If you are not in need of school supplies you can skip this section)

Rows	Shirt Size	Pants Size	Shoe Size	Description of students style	Students Favorite Color	Size: Notes that would be helpful! (Example: Juniors/ Womens/ Mens/ Boys)
Student 1
Student 2
Student 3
Student 4

Additional Supplies (Please select requests)

Rows	Backpack Requested	LunchboxReuqested
Student 1
Student 2
Student 3
Student 4

Additional Information that may help when we are filling your request!
Please provide proof of residency and income! We will accept a current electric bill or current lease for proof of residency. Please provide proof of income with the last 4 pay stubs or income statements.

E-mail:mheaton@colchesterct.gov

Fax: (860)537-7255

Address: 127 Norwich Ave Colchester, CT 06415

(attention to Youth and Social Services)
Thank you for taking the time to complete this form. Have a wonderful day!
Proof of eligibility and Residency

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Colchester Youth and Social Services