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Central Daviess County Family Resource Center Request Form
If you, or your family, are in need of supplies from Highland or Country Heights Elementary School, please fill out this form and someone will contact you.
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* Indicates required question
Email
*
Your email
School
*
Whitesville
Higland
Student Last Name
*
Your answer
Student First Name
*
Your answer
Parent Name
*
Your answer
Preferred method of contact (please list phone number or email)
*
Your answer
Student Grade
*
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
I have students in multiple grades
How many children under 18 are in your household
*
Your answer
Other students in household/ Grade/ Teacher
Your answer
I need help with... (select all that apply)
*
Food
Weekend Food Bags
Clothing
School Supplies
Hygiene Products
Bills Assistance
Medical Needs/ Signing up for insurance
I need a support group or mental health resources
Household items
Other
Required
If you are requesting food, please list any food allergies your child has.
Your answer
Reason for need request
*
Emergency (fire, natural disaster, pandemic, ect.)
Loss of income
Family reasons
Other
Required
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