THANSGIVING BOX APPLICATION
Applicant Name (Head of Household)
*
First Name
Last Name
County of Residence
*
Citizenship:
*
Please Select
US Citizen
Naturalized Citizen
US National (Born in Amercan Samoa/Swain Islands)
Lawful permanent resident
Refugee
Asylee
Parolee
Conditional Entrant
Cuban/Haitian Entrant
Battered Immigrant/Children
Trafficking Victim (T Visa)
Afghan/Iraqi National
American Indian born in Canada
Federally Recognized Indian Tribe (born outside USA)
Individual covered under Compacts of Free Association (COFA)
Undocumented resident
Non-Eligible Legal Resident
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Housing Type:
*
Please Select
Own
Rent
Public Housing
Other Permanent Housing
Homeless
Temporarily living with friends/family
Other
Upload ID:
*
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Driver's License, Passport, Birth Certicate, etc.
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HOUSEHOLD INFORMATION
Please complete the fields below, starting with the Applicant/Head of Household. You must list every individual residing in the household, including children.
Head of Household / Household Member #1
*
Household Member #2
Household Member #3
Household Member #4
Household Member #5
Household Member #6
Household Member #7
Household Member #8
*I have additional household members to add to my application:
Yes
No
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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:
*
PLEASE UPLOAD INCOME DOCUMENTATION HERE:
*
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Tax Return, Paystubs, SSI/SSDI Statement, SNAP, etc.
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The Thanksgiving Box includes turkey and a variety of shelf-stable foods such as canned vegetables, stuffing, gravy, mashed potatoes, etc. Specific food items may vary depending on availability.
If you, or someone in your home have food allergies, please list them below:
Celiacs Disease, Lactose Intolerance, etc.
If there are certain Thanksgiving food items your household does not eat or would not use, please let us know.
*
No, we are happy to receive all available items.
Yes
Please list any food items you would prefer not to receive:
Terms & Conditions
I hereby declare that the information and documentation I provided is accurate and true to the best of my knowledge. I understand that, if approved, seeds or any other resources provided is for personal use only, not to be used for profit.
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