The Village MAIN Request Form

1
I am seeking help to raise a child due to affordability challenges and live in Renfrew County.* This field is required.
YES
2
The Village GET HELP network is temporarily on hold.

Due to the Canada Post strike we cannot take orders at this time, as we have no way to distribute them.

We are incredibly sorry for the inconvenience and we will open applications again as soon as we find a solution.

Please call or visit your local food bank if you need immediate assistance.
3
Name of Person Making the Request* This field is required.Clients, Representatives, Service Providers who are raising children facing affordability challenges.
First Name
Last Name
4
The Best Email to Reach You * This field is required.Type in your email address normally associated with your client account.
example@example.com
5
Most of our benefits are mailed. Please provide your current address. * This field is required.We compare this address to the one on your client account.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
The Best Phone Number to Reach YouWe compare the phone numbers provided to your client account information.
Please enter a valid phone number.
7
How Many Children and/or Youth are you making the request for?* This field is required.Let us know the number of children/youth tied to this request. We only provide benefits for the needs of local children and youth.
Type a number of children in your care. We compare this to the information in your account.
8
Please choose one way we can offer help for this request.* This field is required.We can only take requests in one area of need at a time using this form.
Back to School Supplies for Student(s)
School Supports such as Field Trips & Special Events
Winter Wear for Infants, Children, and Youth
Access to Food and Household Supplies
Information to Help with Other Needs
Something Else
9
SEPTEMBER SCHOOL FUND CLOSED

Our Back to School budget has been fully expensed for September 2025.

Check back on October 1, 2025 to resubmit your request.
10
Back to School Benefit Options* This field is required.We offer $25 Gift Cards for each student in need. They are mailed to the address on your account. You can pick more than one option here if you want a variety of cards. Choose only 1 if you only have 1 child in your care. We use your account to know how many children you are caring for.
Walmart Gift Card
Amazon Gift Card
Other (not guaranteed)
11
You have selected "other" for the Gift Card option. Please let us know which store(s) you hope to get a Gift Card for your Student(s) from. Please name the store you want for the Gift Card. No guarantee.
Store Name
12
Please tell us about what you need for the school trip or special event with the school your student attends. Clearly state what you need.
What do you need?
13
Please tell us about what winter wear is needed for your child. Clearly state what you need.
What do you need?
14
Please tell us about what food or household supplies are needed for your child. Clearly state what you need.
What do you need?
15
Please tell us about what information you need to answer your question(s).Cleary state what information is needed.
What information is needed?
16
Please tell us what you are in need of to support your child(ren). Clearly state one need at a time here.
What is one thing needed now?
17
Thank you for taking the time to tell us what is needed to support you and your child(ren) at this time.

We will do what we can to provide it.

If you are a new client, we will be in touch to complete your account

If you are a returning client, we will use the information on your file to process the order

If the information entered here does not match your profile, we will be in touch.

Click SUBMIT to complete your Village Get Help request form.

We will process your order as quickly as possible. Please do not resubmit.
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