JCMA 2024 Christmas Store Application

JCMA 2024 Jackson County Christmas Store Application
Senior (65+)/Disabled

When: Friday, December 13
Where: First Baptist Church, 404 Juniper Dr., Holton
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Zip Code
Phone Number
Cell Number
E-mail
Please mark ONE choice from the list of gift cards below.*

WalmartMedical PharmacyCecil K'sCasey'sDairy QueenTaco Bell7-11Jhett's
# of Large Dogs
# of Small Dogs
# of Cats
Instructions:

Please attach one of the following
- Food Stamp Verification (Vision Card Front and Back) - Must be signed
- Bank Statement
- Social Security Monthly Statement
Please also attach a copy of your Driver's License or current Photo ID.

Incomplete applications will not be accepted.
Upload files here*

Click To Upload

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You must be a resident of Jackson County Kansas to apply.

Applications are due no later than Friday, November 15.

If you have printed this form, please mail or drop off the completed application to First Baptist Church (404 Juniper Dr.) or Holton Post Office (328 Pennsylvania).

If you qualify for the Christmas Store, you will receive notification by text or mail no later than December 1. We will deliver your items to you on Friday, December 13.

Each qualifying household will receive a food basket, an essential bag and gift card of choice.

If you have any questions, please call Jennifer Ingels at 785-851-1011 or Gayle Moulden at First Baptist Church at 785-364-3423.
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