Holiday Assistance Form

Holiday Assistance Application

Family Connections Resource Center Holiday Assistance
Application Deadline is Thursday, November 5th, 2026

No more applications will be accepted after this date!
This will give us the necessary time to ensure we are able to run this program smoothly and efficiently. Please be patient and understanding as this is the first time Ms. Gabby and Mr. Seiter will be running this program on their own. The information here will only be seen by them. Thank you!

Understand that by requesting and receiving this assistance you will be required to do the following:
- You must provide eight (8) hours of volunteer service through the Family Resource Center.
- You must have returned a Household Information Form (Lunch Form) to the school district.
I have read and understand the above letter about the guidelines for requesting holiday assistance.
Applying for help with:
Have you applied (or do you plan to apply) at any other agency or church for holiday help? (If yes, please include where)
Please tell us the circumstances surrounding your request for help.
The Following Information Must Be Supplied AND MUST BE CORRECT to be Considered
Full Name

First NameLast Name
Email Address
Address

Street Address

CityState / Province

Postal / Zip Code
ACTIVE Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have transportation to pick up food/and or gifts?
The Holiday Assistance Program typically doesn't serve students over the age of 18.

All Information Requested is Required!

Rows	Name	Gender	Age	Grade	Shirt Size	Pant Size	Shoe Size	Toys, games, Likes, Interests, etc.	School
Child #1
Child #2
Child #3
Child #4
Child #5
Child #6

How many people are in your household?
I understand that the Family Resource and Youth Services Centers may need to discuss my situation with other agencies, churches and providers in order to help me most effectively. My signature permits the Family Resource and Youth Services Centers to do so.

Upon completion of your application, the Family Connections Resource Center will review the application and you will be notified by mail or via telephone as to whether or not you have been accepted for the assistance program.
Signature:
Should be Empty:

Holiday Assistance Application