June 2022 Toiletry Drive

This event will be held curbside, to ensure social distancing. Registration is required. If you are unable to fill out an application on your own, please feel free to have a family member or friend assist you.

CILSJ only serves persons with disabilities, residing in either Camden OR Gloucester Counties, not including Camden City, NJ. Camden City residents can contact (856) 966-0800 for assistance.
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Birthdate *

Month Day Year
Date
Please upload a photo ID/birth certificate for identification purposes. *

Cancel of
Are you or a member of your household disabled? *

No Yes
Please upload proof of disability. (Photo/Scanned document of Doctors information with diagnosis/diagnoses) *

Social Security documentation IS NOT proof of disability. It is proof of income.
Cancel of
Please upload proof of address. This can be a simple photo of a current bill with the address listed. *

Cancel of
How many adults are in the household? *
How many children are in the household? *
Please use the space below to inform us of toiletry items that you are in need of. CILSJ will try our best to accommodate families in need. Please remember to include any sizes for personal care items. *
Are you homebound? *
Homebound, meaning, you are not able to leave the home for any reason and you have no assistance and no transportation.
Signature *

Clear
Thank you for completing your application to receive a toiletry basket during our drive-thru event. Center for Independent Living of South Jersey, Inc. is a 501(c)(3), non-profit organization, providing services to persons with disabilities and their families in both Camden and Gloucester Counties.

The week of the event you will receive a phone call and an email confirming your pickup during the event. If you have any questions or concerns, feel free to contact us via the contact information below. Thank you.

Contact information:

Salema Banner, Program Manager/Disability Advocate

Email: salemabannercilsj@outlook.com

Phone: (856) 853-6490

Website: www.cil-sj.com

Facebook: www.facebook.com/cilsouthjerseyinc
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This event will be held curbside, to ensure social distancing. Registration is required. If you are unable to fill out an application on your own, please feel free to have a family member or friend assist you.