Mahtomedi Schools Backpack Program (SY 22-23)

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Please fill out one form per student.

Once per week, a small bag of non-perishable breakfast, lunch and snack items will be discreetly provided to the student to help meet nutritional needs throughout the week at home and/or in the classroom during snack times.
This program is possible due to our partnership with the Mahtomedi Area Food Shelf and MAEF.

Each student in the Backpack Program will also receive a Birthday Bag the month of their birthday. These Birthday Bags, donated by the 3 Harris Brothers' Courage Club, includes cake mix, a disposable cake tin, frosting, a candle, and a small age-appropriate gift.

Nothing needed to qualify! Open to any Mahtomedi PreK-12 student.

If you have any questions, you may contact the district social worker:
Ali Middlebrook, MSW, LGSW.
Email: ali.middlebrook@isd832.net
Office: 651-407-2304
Cell: 651-468-9634

Email *

Student First Name *

Student Last Name *

School Student Attends *

Wildwood Elementary School

O.H. Anderson Elementary School

Mahtomedi Middle School

Mahtomedi High School

Grade *

Preschool

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

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6th Grade

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8th Grade

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10th Grade

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12th Grade

K-5 Students: Teacher (if you don't know, leave blank)

BIRTHDAY BAGS: Thanks to generous donations from a local non-profit, 3 Harris Brothers' Courage Club, each student enrolled in the Backpack Program will get a Birthday Bag with their weekend food bag the month of their birthday. Each Birthday Bag will include a disposable cake pan, cake mix, frosting, a candle and a small, age-appropriate gift. If you do not want your student to receive a Birthday Bag, please email Ali Middlebrook, District Social Worker, at ali.middlebrook@isd832.net to opt out. *

I have read the statement above.

Student Birthday Month *

January

February

March

April

May

June

July

August

September

October

November

December

Each Birthday Bag comes with one or two small gift items. Please choose which type of gift items your student would enjoy. (Items listed below are examples of what may be included as a gift in the Birthday Bag). *

Option 1: Items like trucks and action figures (for elementary students) or masculine-style socks, body sprays or other self-care items (for older students)

Option 2: Items like dolls (for elementary students) or feminine-style socks, body sprays, make up items or other self-care items (for older students)

Option 3: Items like small games or coloring books (for elementary students) or gender non-specific socks, body sprays or other self-care items (for older students)

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Parent/Guardian

Teacher or other staff member filling out on behalf of parent/guardian and with their permission.

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