2025 GOG Christmas Assistance Application

Graces of Gurley Christmas Assistance Application 2025:

Please complete this application truthfully and thoroughly. As part of the application process, you’ll be asked to schedule a face-to-face meeting to complete your child’s wish list and choose a date for a two-hour information session. Both of these meetings are important and are required to receive services.We understand that schedules can change—if you're unable to attend your selected time, please give us a call at 469-556-9083 and we’ll be happy to help you reschedule. Please keep in mind that missing either meeting without rescheduling will result in your application being canceled. GoG reserves the right to deny applications known to be filled out falsely, based on GoG knowledge of families that we serve. Applicants may or may not be allowed to correct falsified information. This is at the discretion of GoG.
Parent/Guardian Name:

First NameLast Name
Spouse/significant other living in same household

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
First Child's Name

FIrst & Last NameGradeDate of Birth
Second Child's Name

FIrst & Last NameGradeDate of Birth
Third Child's Name

FIrst & Last NameGradeDate of Birth
Fourth Child's Name

First & Last NameGradeDate of Birth
Fifth Child's Name

FIrst & Last NameGradeDate of Birth

MONTHLY HOUSEHOLD EXPENSES

Rows	Payment Amount
Rent
Utilities/Propane
Phone
Medical
Car payment(s)
Insurance
Loans
Spousal Support
Child Care
Furniture
Food/Necessities
Credit Card(s)
Cable/Internet
Other

Total Household Expenses Calculation:
Do you receive government assistance for food?
If not, please explain above
Landlord's name and phone number (if applicable):

INCOME SOURCES (you must list everyone living with you). Put the number 0 in column one if the category does not apply. Put N/A in column two if the category does not apply:

Rows	Parent/Guardian	Spouse/Other Adults 18 & over
Place of Employment
Weekly/Monthly Salary
Food Assistance/SNAP
Child Support
WIC
SSI/Disability
Spousal Support
Other

Total Income Calculation
Total number of people residing in household:
For elderly/disabled, are you eligible for SSA/SSI/SSD? If so, do you receive it?
If not, please explain above
If you are unemployed, are you receiving unemployment?
If not, please explain above
I certify that the information provided on this application is accurate. I understand that withholding of information or giving false information may result in a refusal of services by Graces of Gurley. I understand it is my repsonsibility to inform Graces of Gurley if any information in this application changes and that this information may be shared with other community partners to help better serve you.
First Name Last Name Date
Signature
In order to receive Christmas assistance, you are required to participate in a one-on-one interview with a Graces of Gurley representative. You will also be required to attend a 2 hour information session. Please use the calendars below to schedule your interview time and information session.

If you are unable to make your scheduled time, call 469.556.9083 to reschedule. Also, if one of these available time slots will not work for you, call or text to set up a specific time. Please note: Both the interview and class are REQUIRED for you to receive assistance. The info sessions on are Oct 18, 19, or 20th. You can scroll through the dates on the calendar at the bottom to select a time on one of these days.
Appointment for Christmas Assistance located at the Graces of Gurley building
2 Hour Informational Session and Finance Awareness
Should be Empty:

Graces of Gurley Christmas Assistance Application 2025:

In order to receive Christmas assistance, you are required to participate in a one-on-one interview with a Graces of Gurley representative. You will also be required to attend a 2 hour information session. Please use the calendars below to schedule your interview time and information session.