Clone of 2025 GOG Christmas Assistance Application

Graces of Gurley Christmas Assistance Application:

December 15-17, 2026
Please read instructions and complete this application truthfully and thoroughly.

To be eligible for Christmas assistance through Graces of Gurley (GoG):

1. The application must be completed by the primary parent or legal guardian of the child or children applying for assistance.

2. At least one child in the household must be in 8th grade or younger and either live in the 35748 ZIP code or attend Madison County Elementary School.

3. Applicants must not have received Christmas assistance from Graces of Gurley for the past five consecutive years.

4. You may not complete applications on behalf of extended family members.

5. As part of the application process, you will be asked to schedule a face-to-face meeting with our staff. This meeting helps us learn more about your family and prepare for your participation in our upcoming Christmas Market. Attendance at this meeting is required to receive a Christmas voucher to shop at the market.

We understand that schedules can change. If you are unable to attend your scheduled meeting, please call us at 469-556-9083 to reschedule. Failure to attend your meeting without contacting us to reschedule may result in your application being canceled.

Graces of Gurley reserves the right to deny any application that contains false or intentionally misleading information. This determination may be based on information provided in the application as well as GoG's existing knowledge of the families we serve. At GoG's discretion, applicants who provide false information may or may not be given an opportunity to correct their application.

I have read and understand the requirements to receive the privelege of shopping at the Christmas Market.
Signature
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
By signing below, I certify that all information provided in this application is accurate and complete to the best of my knowledge.

Accuracy of Information: I understand that providing false information or intentionally withholding details may result in a denial or discontinuation of services by Graces of Gurley.

Keeping Us Updated: I agree that it is my responsibility to notify Graces of Gurley if any of my household or contact information changes.

Community Care Collaboration: To ensure we can serve you as effectively as possible, I understand that this information may be shared confidently with trusted community partners.
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. Please use the calendar below to schedule your interview time.

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: The interview is REQUIRED for you to receive assistance.
Appointment for Christmas Assistance located at the Graces of Gurley building
Should be Empty:

Graces of Gurley Christmas Assistance Application:

In order to receive Christmas assistance, you are required to participate in a one-on-one interview with a Graces of Gurley representative. Please use the calendar below to schedule your interview time.