2023 Christmas Assistance Application (Pensacola)

PLEASE NOTE: Our agency relies on community donations. Completing this form does not guarantee that you will receive Christmas assistance. Please make sure preparations are made ahead of time in the event we are unable to provide for your children.
Today's Date*

MonthDayYear
Date
Did you receive Christmas assistance in 2022 from Catholic Charities?*

YesNo
Please fill in the information and questions on this page based on the Head of Household.
Answers to these questions will not affect the acceptance of your application and are for agency informational purposes only.
Name*

First NameMiddle InitialLast Name
Maiden Name
*if applicable*
Date of Birth*

MonthDayYear
Social Security #*
Address*

Street Address

Apartment #, Unit #, Building #

CityState

Zip Code
Preferred Phone #*
Alternative Phone #
Preferred Email*
example@example.com
Do other adults live within this household?*

YesNo
Other Adults in Household*
Race*
Religious Preference*
Marital Status of Household Adults*
Please Specify Other Race*
Please Specify Other Religious Preference*
Please Specify Other Marital Status*

Please fill in the information below based on the children 13 and under living within the household.
Click the + Add Child button to add a new line for each child's information.
Gift suggestions must be under $30; please include details such as color, race, and/or type for gift suggestions such as dolls.
Size Categories: Please select the sizing categories that correspond with the sizes your child(ren) wear.*

Infant/ToddlerChild/YouthJuniors' and Adult
Infant and Toddler Sizes*
Child/Youth Sizes*
Juniors'/Adult Sizes*