2020 Christmas Assistance
Contact Information
Outreach Advocate/ 910-343-0703

There is NO guarantee that your family will be provided assistance. ALL assistance is dependent on donations from the community, and matches are made when items come iin AND match the needs of the applicant. Should we be able to provide assistance, an advocate will contact you. We ask that you NOT call to check on the status of your application, as this will only slow down the process. Thank you for your understanding!

There are three tiers of assistance available:
1. Shelter Residents
2. 1st time Christmas assistance recipients. You can only apply for children that are currently in your care. You will need a state issued ID.
3. Previous Christmas assistance recipeints. You can only apply for children that are currently in your care.

Guidelines:
-Completion of application does NOT guarantee assistance.
-When your family has been accepted for assistance, you will be contacted. Please ensure an advocate has your updated contact information. It is your responsbility to notify the agency if your information changes.
-An advocate will contact you regarding scheduling a pick-up time. Do not initiate contact on this matter.

Deadline for Applications:
November 2, 2020
5:00 pm

**The Deadline has PAST so if you are filling this form out after November 2nd, you are going to be put on our waiting list, Christmas assistance is not guaranteed.
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Parent's Information
By completing this form, you are NOT guaranteed Christmas assistance. If your contact information changes, please inform a staff member of the change. **The Deadline has PAST so if you are filling this form out after November 2nd, you are going to be put on our waiting list, Christmas assistance is not guaranteed.
Name:
Street Address:
City, State, & Zipcode
Date of Birth
MM
/
DD
/
YYYY
Phone Number
Email
Have you ever received Christmas Assistance from Domestic Violence Shelter and Services before?
Clear selection
If so...when?
Parent's Information
By completing this form, you are NOT guaranteed Christmas assistance. If your contact information changes, please inform a staff member of the change. **The Deadline has PAST so if you are filling this form out after November 2nd, you are going to be put on our waiting list, Christmas assistance is not guaranteed.
Gender
Clear selection
Age
Clothing Size
Shoe Size
Favorite Color
Item 1
Item 2
Item 3
Child 1
By completing this form, you are NOT guaranteed Christmas assistance. If your contact information changes, please inform a staff member of the change. **The Deadline has PAST so if you are filling this form out after November 2nd, you are going to be put on our waiting list, Christmas assistance is not guaranteed.
Name/ Last Four #SSN
Gender
Clear selection
Age
Clothing Size
Shoe Size
Favorite Color
Item 1
Item 2
Item 3
Child 2
By completing this form, you are NOT guaranteed Christmas assistance. If your contact information changes, please inform a staff member of the change. **The Deadline has PAST so if you are filling this form out after November 2nd, you are going to be put on our waiting list, Christmas assistance is not guaranteed.
Name/ Last four of #SSN
Gender
Clear selection
Age
Clothing Size
Shoe Size
Favorite Color
Item 1
Item 2
Item 3
Child 3
By completing this form, you are NOT guaranteed Christmas assistance. If your contact information changes, please inform a staff member of the change. **The Deadline has PAST so if you are filling this form out after November 2nd, you are going to be put on our waiting list, Christmas assistance is not guaranteed.
Name/ Last Four #SSN
Gender
Clear selection
Age
Clothing Size
Shoe Size
Favorite Color
Item 1
Item 2
Item 3
Child 4
By completing this form, you are NOT guaranteed Christmas assistance. If your contact information changes, please inform a staff member of the change. **The Deadline has PAST so if you are filling this form out after November 2nd, you are going to be put on our waiting list, Christmas assistance is not guaranteed.
Name/ Last four #SSN
Gender
Clear selection
Age
Clothing Size
Shoe Size
Favorite Color
Item 1
Item 2
Item 3
Submit
Clear form
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