2025 Holiday Program Application

2025 Holiday Gift Program Application
Thank you for applying for our annual gift bag. This application must be completed and submitted by September 30, 2025, latest. We will let you know by November 15, 2025 if your application is approved. We will also let you know at that time the delivery date for gift bags which is, typically, one or two weeks before Christmas.
Where Will You Receive Delivery of Your Gift Bag *
1 - Telluride, Mtn. Village, Down Valley; 2 - Norwood; 3 - Redvale, Egnar, Dove Creek; 4 - Naturita, Bedrock; 5 - Nucla
Name of Applicant*

First NameLast Name
Age*
Cell Phone Number*
Email*
example@example.com
Mailing Address*

Street or PO Box

Street Address Line 2

CityState / Province

Postal / Zip Code
Delivery Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Special Delivery Notes or Instructions
Please Check Any and All Assistance Programs You Subscribe To*

Food StampsSSIMedicaid (Children)Medicaid (Disability)Medicaid (Senior)OtherNone of the Above
If you chose "Other," please explain here.
Additional Household Members (Up to 6, Maximum)
Please Note: You may only apply for actual family members who are residing in your home. If there are others in your home who qualify but are not members of your family, they should apply on their own, separately.
Member1 First Name
Member1 Last Name
Member1 Gender
Member1 Age
Member2 First Name
Member2 Last Name
Member2 Gender
Member2 Age
Member3 First Name
Member3 Last Name
Member3 Gender
Member3 Age
Member4 First Name
Member4 Last Name
Member4 Gender
Member4 Age
Member5 First Name
Member5 Last Name
Member5 Gender
Member5 Age
Member6 First Name
Member6 Last Name
Member6 Gender
Member6 Age
Total Number of Household Members, Including Yourself*
If your household exceeds 6 members - in addition to yourself - all of whom are fully resident in your home, please call Peter at (970) 708-3839 (English) or Dominique (970) 708-4051 (Spanish).
How Did You Learn of Our Holiday Program?
If you chose "Other," please explain here.
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2025 Holiday Gift Program Application

Additional Household Members (Up to 6, Maximum)