Easter hamper application
Application
This is an application only. It does not guarantee a hamper. Those selected willl be contacted. Application will close on March 26 2026. Please note You must be a member of Campaign to Empower the community group for a minimum of 2 months to receive a hamper
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you?
*
Female
Male
Other
Are you part of the LGBTQIA2S+ ( this question is only for statistic and funding purposes. )
*
Yes
No
Unwilling to answer
Ethnicity ( for funding purposes)
*
Caucasian: North American
European: English, Irish, Scottish, French, German, Italian, Ukrainian, Polish.
Asian: Chinese, Indian, Pakistani, Filipino, Vietnamese, Korean, Japanese.
African: Nigerian, Ethiopian, Somali, Ghanaian, Congolese
Caribbean: Jamaican, Haitian, Barbadian, Trinidadian.
Latin, Central, & South American: Mexican, Brazilian, Colombian, Chilean, Salvadoran.
Middle Eastern & North African (MENA): Arab, Iranian, Lebanese, Egyptian, Turkish.
Indigenous (Canada/US): First Nations, Métis, Inuit, Cherokee, Navajo, Sioux.
Oceanian: Filipino, Polynesian, Melanesian.
Other
Household income source
*
Aish or Income support
Employment
Employment insurance
Old age security
How many adults in your household?
*
Names and ages of All children in your household
*
Allergies
*
Protein choice
*
Turkey
Chicken
Ham
No protein
Submit
Should be Empty: