JCMA 2025 Christmas Bureau Application

JCMA 2025 Christmas Bureau Application
Senior (65+)/Disabled

When: Friday, December 12
Where: First Baptist Church, 404 Juniper Dr., Holton
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province
Phone Number
Cell Number
E-mail
Total # of adults in household*
Total # of children in household*
Please mark ONE choice from the list of gift cards below.*

WalmartMedical PharmacyCecil K'sCasey'sDairy QueenTaco Bell7-11Jhett's
# 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

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

Applications are due no later than Friday, November 14.

If you have printed this form, please mail or drop off the completed application to First Baptist Church (404 Juniper Dr.) or Holton Post Office (328 Pennsylvania).

If you qualify for the Christmas Store, you will receive notification by text, email, phone or mail no later than December 1. We will deliver your items to you on Friday, December 12.

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

If you have any questions, please call Jennifer Ingels at 785-851-1011 or Gayle Moulden at First Baptist Church at 785-364-3423.
Should be Empty: