2026 Holiday Assistance

2026 Holiday Assistance
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
How many children do you have?*
Please enter your child(ren)'s first name and age:*
Enter 'NA ' in boxes if you have less children than listed
Please list child(ren) interests, clothing/shoe size, and/or gift ideas*
PLEASE KEEP ALL GIFT REQUESTS AT A REASONABLE PRICE POINT (<$200)
Please list local grocery stores in your area:*
I affirm that all statements and representations made are honest and accurate.
No information has been intentionally falsified, omitted, or misrepresented.
I am fully aware that providing false or misleading information may result in denial to apply for and/or receive assistance from Ennie Mini, Inc. in the future.

By signing below, I certify that I have carefully reviewed the information provided and that I stand by its truthfulness and accuracy.
Signature*

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