APPLICATION FOR ASSISTANCE
JMB KIDZ INC. A 501c3 Organization
Name
*
Address
*
Date of birth
*
/
Month
/
Day
Year
Date
School attending
*
Parent/Guardian Name
*
Telephone
*
Format: (000) 000-0000.
Describe the applicant's need in 100 words or less
*
Date funds are needed
*
/
Month
/
Day
Year
Date
Person completing this form
*
Relationship to the applicant
*
Telephone number:
Format: (000) 000-0000.
Program/address where check should be sent
*
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