School Supplies Application
2026-2027 School Year
Head of Household
*
First & Last Name
County
*
Email
*
Phone
*
Address
*
Street Address
City
State / Province
Postal / Zip Code
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Household Information
List every household member that resides in the home. List applicant/head of household first.
HOUSEHOLD INFORMATION
*
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HOUSEHOLD INCOME INFORMATION
To qualify for services, you must complete this page and provide income verification.
Select all types of income you've received in the past 12 months.
*
Employment
SSI/SSDI
Child Support
Self-Employment
Interest
Pension
Unemployment
TANF/SNAP
General Assistance
LIHEAP
Other
None
TOTAL ANNUAL INCOME FROM ALL SOURCES
*
UPLOAD ALL SUPPORTING INCOME DOCUMENTATION:
*
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Current Housing
*
Own
Rent
Experiencing Homelessness
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STUDENT INFORMATION
Eligible households will receive ONE School Supply Kit per student (K-12th Grade). Please list the students (K-12 Grade) in your household in need of supplies.
Student(s)
*
Does your household receive school supply assistance from any other agency?
*
Yes
No
If yes, please list agency/program below.
Answering yes will not affect your eligibility for ROCS School Supplies.
By signing below, I declare and affirm that everything submitted is true to the best of my knowledge. If I am approved and receive school supplies through this program, I agree that they are for personal use only and not for profit.
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