APPLICATION FOR ASSISTANCE
JMB KIDZ INC. A 501c3 Organization
Name
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Address
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Date of birth
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Month
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Day
Year
Date
School attending
*
Parent/Guardian Name
*
Telephone
*
Describe the applicant's need in 100 words or less
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Date funds are needed
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Month
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Day
Year
Date
Person completing this form
*
Relationship to the applicant
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Telephone number:
Program/address where check should be sent
*
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