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2022-23 School Supplies Form
Please complete one form per student.
Our Family Advocate will deliver School Supplies to your child's school prior to the first day of school, based on supplies that have been donated.
VH Preschool-6th grades ONLY can pick up FREE School Supplies at Yungeberg Drug in BR and DO NOT NEED TO COMPLETE THIS FORM.
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* Indicates required question
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Parent/Guardian Address
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Your answer
Parent/Guardian Phone Number
*
Your answer
Parent/Guardian email address
Your answer
Choose the School your child attends
*
Choose
USD#380-Frankfort
USD#380-Centralia
USD#498 Valley Heights
Child's first name
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Your answer
Child's last name
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Your answer
Student is male or female
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Male
Female
Prefer not to answer
Child's Grade
*
Your answer
If this student is in Jr or Sr High School, please provide a list of their classes., i.e. English, Math, Algebra, Geometry, Science, Ag, Social Science, Computers, Consumer Ed, etc.... PLEASE DO NOT SUBMIT UNTIL YOU HAVE THE SCHEDULE!
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Your answer
School supplies are limited please choose one
My student has a back pack.
If a backpack is available, my student is in need of a new back pack.
My student will have the opportunity to shop for a new backpack before school starts.
Clear selection
School supplies are limited please choose one
My student has a water bottle for school.
If a water bottle is available, my student is in need of a new water bottle.
My student will have the opportunity to shop for a new water bottle before school starts.
Clear selection
I am interested in other programs and services such as, Mental Health Resources, Food Referral Assistance, Winter Wear/clothing, Hygiene or Household supplies, baby items, etc. Please follow up with me after school starts.
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Yes
No
Maybe
THANK YOU! Jayne Whitson, Family Advocate
serving students and families in USD#380 & USD#498 based on needs, not income.
To donate or refer a need please contact Jayne via cell, 612-202-7366 or email
jawhitson@valleyheights.org
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