Care Package Contact Form

Care Package Contact Form

Hey there! We'd love to continue supporting you throughout your journey after high school. Please complete this form to provide us with your most recent contact information, including your address so we can send you care packages!
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What year did you graduate high school?

Other
Are you currently enrolled in a post-secondary institution?

Other
What's the name of the post-secondary where you're currently enrolled?
Mailing Address (your care package will be sent here)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this an on-campus college/dorm address?
What's the name of your college/university?
What's the name of your college dorm/residence hall?
Are there any special instructions we need to follow when shipping your care package?
Do you have any food allergies we should be aware of?
(Optional) Do you have ideas for items you'd like us to include in the care packages this year? Please keep in mind we have a limited budget and a lot of packages to send. :-)
Please upload a picture of yourself!

We will share your photo with the volunteers who help assemble your care package and the people who donate money/items for your package (e.g., in a "thank you" post on social media).

Our volunteers and donors love seeing the people they are supporting! However, if you don't feel comfortable sharing your pic, you may upload an image of a cute pet or something else. :-)
Photo upload

Cancelof
What is your current age?
What is your date of birth?

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Parent/Guardian Signature
Should be Empty: