CHS Holiday Giving Sign up (Deadline to complete is October 21, 2022) Please only fill this form out if you have a student at CHS. 
The Holiday Giving Project has provided Thanksgiving and December holiday assistance to low-income households for over 30 years. A network of social workers, school counselors, and human service professionals refer families in need of assistance. Local non-profits, faith-based organizations, and public agencies serve Holiday Giving recipients, as donations are available. If you and your family are in need and would like to be referred for possible assistance for the holiday season, please complete this referral form to provide the required information. Resources are limited. While a referral is not a guarantee of assistance, the Project helps as many families in need as donations allow. Please complete this form no later than Monday, October 21, 2022.
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I request that my family be referred to the Holiday Giving Project for assistance. I understand that my information will be entered in the Holiday Giving Project database and will be shared only with authorized Holiday Giving Project partners and volunteers, including possibly for delivery of assistance to my home and for communication by phone, email or text messaging. I further understand that I am responsible to inform the person making this referral if my family situation changes, such as my address. I have not been referred to this program by any other organization. * *
Last Name (of person filling this out) *
What is your Clarksburg High School Student Name (First and Last)? *
Email Address
Phone Number *
Additional Phone Number
Preferred Language *
Co-housing with another family? *
What is your address? Please include apartment number, if applicable *
I would like assistance with the following occasions (check all that apply): *
Required
Number of Adults in Household (18 or older) *
Number of Children in Household (17 or younger) *
Please list any dietary restrictions
Child #1 Information (Please include: first name, last name, age, & gender)
Child #2 Information (Please include: first name, last name, age, & gender)
Child #3 Information (Please include: first name, last name, age, & gender)
Child #4 Information (Please include: first name, last name, age, & gender)
Child #5 Information (Please include: first name, last name, age, & gender)
Child #6 Information (Please include: first name, last name, age, & gender)
Child #7 Information (Please include: first name, last name, age, & gender)
Child #8 Information (Please include: first name, last name, age, & gender)
Does your family have any other needs (optional question)?You may identify other needs for your family using the checkboxes on the left. By checking a box, you consent to possibly being contacted by or connected to other programs. This may include the mailing of information to your home. Checking the box is not a guarantee of service.Food Assistance
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