Clone of JCMA 2025 Christmas Bureau Application

JCMA 2026 Christmas Bureau Application
Senior (65+)/Disabled

When: Friday, December 11
Where: First Baptist Church, 404 Juniper Dr., Holton

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

City

Phone Number

Format: (000) 000-0000.

E-mail

Total # of adults in household

Total # of children in household

List all adults in your household

Please mark ONE choice from the list of gift cards below.

How do you prefer to be contacted?

Dog and cat food is donated. Availability may be limited.

# of Large Dogs

# of Small Dogs

# of Cats

Instructions:

1. Proof of income - upload/attach one of the following:

SNAP Verification (Vision Card Front and Back) - Must be signed
Bank Statement - shows total household income
Social Security Monthly Statement and verification of total household income

2. Please also attach a copy of your Driver's License or current Photo ID.

Incomplete applications will not be accepted.

Acceptance is based on total household income.

Upload files here

Click To Upload

You must be a resident of Jackson County Kansas to apply.

Applications are due no later than Friday, November 13.

If you qualify for the Christmas Store, you will receive notification by text, email, phone or mail the first part of December. We will deliver your items to you on Friday, December 11. If you will not be home that day, please contact us by December 8.

Each qualifying household will receive a food basket, an essential bag and gift card of choice.

If you have any questions, please call Gayle Moulden at First Baptist Church at 785-364-3423.