Register for Help with School Supplies
A Ministry of the Hardee County Ministerial Association:
Hardee Help Center
Attn: Stephanie Leakey, Client Services Coordinator
713 E. Bay Street
Wauchula, FL 33873
Tele: 863-773-0034

Help with school supplies for Hardee County students (K-12) is available.

PRE-REGISTRATION IS REQUIRED. NO WALK-INS. APPOINTMENTS REQUIRED.
 
Grade appropriate supplies are distributed in the order registrations are received. School supplies are limited. If the need exceeds the supply available then a wait list will be created and families will be contacted should additional supplies become available, with priority given to lower income families.  

Submit your registration and you will be contacted by phone by a Hardee Help Center Team Member to schedule pick up of your child's school supplies.  
Documents & Information needed:
1. Photo Identification (Only the child's legal guardian can request assistance)
2. Proof of physical address (Must be a Hardee County resident)
3. Child's Name, DOB, 2021-2022 Grade Level, and School (Students must be attending a Hardee County Public School or enrolled in one of the virtual options)

Documents need to be presented when picking up your child's school supplies.  

>>>> The person who is registering/completing this form must be the child's legal guardian and certify the information provided is accurate.  
Sign in to Google to save your progress. Learn more
Applicant's First Name, Last Name (Adult Household Member) *
Are you a member of a local church? If so, which church? *
Phone Number (xxx-xxx-xxxx) *
Current Physical Address (Ex. 713 E. Bay Street, Wauchula) *
Adult Household Member DOB *
MM
/
DD
/
YYYY
Adult Household Member Last Four Social Security Numbers (xxxx) *
Gender? *
Adult Household Member Marital Status: *
Disabled *
Veteran *
Race *
Ethnicity *
Housing? *
Select your households annual income range. *
Number of Household Members? *
Number of children you are registering. *
Child Number 1 (Full Name, DOB, 2021-2022 Grade Level, School Name) *
Child Number 2 (Full Name, DOB, 2021-2022 Grade Level, School Name)
Child Number 3 (Full Name, DOB,  2021-2022 Grade Level, School Name)
Child Number 4 (Full Name, DOB, 2020-2021 Grade Level, School Name)
Child Number 5 (Full Name, DOB, 2021-2022 Grade Level, School Name)
Child Number 6 (Full Name, DOB, 2021-2022 Grade Level, School Name)
Child Number 7 (Full Name, DOB, 2021-2022 Grade Level, School Name)
I acknowledge the information I submitted above, or by phone with Hardee Help Center Personnel was truthful and accurate. No fraudulent information was provided in order to obtain services that I would otherwise not likely qualify for. *
I acknowledge the information I have provided is shared with the local churches, as the Hardee Help Center is a ministry of the Hardee County Ministerial Association. That any willful misstatement of information will be grounds for disqualification AND I may no longer receive assistance through the Hardee Help Center in the future. *
By selecting 'Yes' below I hereby authorize the release without liability, information regarding my residency, employment, income, and/or assets to HARDEE HELP CENTER, for the purposes of verifying information provided as part of determining eligibility for assistance under the Hardee Help Center’s Basic Need Program. I understand that only information necessary for determining eligibility can be requested. Types of Information to be verified: I understand that previous or current information regarding me may be required. Verifications that may be requested are, but not limited to: employment history, hours worked, salary and payment frequency, commissions, raises, bonuses, and tips; cash held in checking/savings accounts, stocks, bonds, certificated of deposits, Individual Retirement Accounts, interest, dividends; payments from Social Security, annuities, insurance policies, retirement funds, pensions, disability or death benefits, unemployment, disability or worker’s compensation, net income from the operation of a business, property exemption status, and alimony or child support payments. *
Signature is required. By typing your name below, this is your digital signature. You are signing this Form electronically. *
Date Submitted *
MM
/
DD
/
YYYY
Time Submitted *
Time
:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Hardee Help Center. Report Abuse
Google Forms