CSSY Tishrei Application 2019

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Bringing the joy and celebration of Shabbos and Yom Tov to hundreds of homes throughout the Crown Heights Community.

Kindly complete this online application so Chevra Simchas Shabbos V'YomTov can better assist you.

Should you find it difficult to complete this application, please contact us at 718-774-5270 or email cssyoffice@gmail.com.

If you feel you may need on-going assistance, please contact CSSY's office after Tishrei.

Applicant First Name *

Last Name *

Spouse Name *

Email Address *

Address *

Apartment

City *

State *

Zip *

Home Number

Cell Phone Number *

Do you rent or own a home? *

Rent an apartment

Own an apartment

Rent a house

Own a house

Other:

Required

Marriage Status *

Single

Married

Widow

Widow with Children

Divorced

Divorced with Children

Separated

Separated with Children

How many children do you have? *

How many children will be home for Tishrei? *

Will you be home for all of Tishrei? (Rosh Hashana, Yom Kippur, & Sukkos) *

Yes

Not sure yet

Are you hosting guests for YomTov? If so, how many?

Do you receive government assistance? Please indicate which: *

Welfare

Food Stamps

Medicaid

Medicare

SSI

HUD

WIC

Section 8

City Feps

IHSS

None of the above

Other:

Required

Do you receive assistance from other local organizations? *

Yes

Required

Reference #1 (Name & Phone Number) *

Reference #2 (Name & Phone Number) *

Comments:

*Applying is not a guarantee that services will be provided.* Though CSSY will attempt to help all individuals in need of kosher food, in the case of limited resource, the organization will prioritize candidates based on need and first come – first serve basis.

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