CBMS Family Needs 2022-2023

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Please complete this form as soon as possible.

Cedar Bluff Student Name, grade *

Parent/Guardian Name *

Parent/Guardian Phone Number *

Please check all that apply: *

I would like food sent home with my child each weekend.

I would like help providing hygiene (ex. shampoo, toothbrush, laundry detergent) supplies for my family.

I would like help providing school supplies for my student(s).

I would like help providing clothing/shoes for my student(s).

I anticipate that my family will need a Thanksgiving/Easter food basket.

I anticipate that I will need help at Christmas providing for my family.

I am in a transitional living situation or I am currently homeless (ex. living in a hotel, in a shelter, or with friends).

My family may need help getting coats this winter. (If yes, please answer the next question.)

Required

How many members of your family will need winter coats?

I have a special request for assistance for my family not listed above.

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