5th Grade Assistance Request Form 2023-2024
Dear Parent or Guardian,
Throughout the year, different organizations request to help students receive free school supplies, clothing and other items of necessity through charitable donations.  The Family Educational Rights and Privacy Act is a federal law that makes student educational records confidential and prohibits the release of student information to these agencies without authorization.  If you are in need of receiving such assistance this school year, please complete the form below to help us work with these agencies in the most efficient way possible.  These assistance programs vary from year to year, and your information must be updated annually for each Tom Cox student.  Authorizing the release of your information does NOT guarantee that you will receive any assistance.
Please feel free to contact us with any questions.
Mrs. Kowis  (5th grade counselor)                                       Mrs. Bodin (6th grade counselor)
jkowis@conroeisd.net                                                            tbodin@conroeisd.net
(281)465-3200                                                                         (281)465-3200

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Email *
Are you in need of assistance with food and/or clothing for your family. *
First and Last name of student. *
Homebase teacher of student: *
Names and ages of other siblings in the home (under 18 yrs of age):
Do you need food assistance/Backpack Buddy program? *
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