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Chapman Outreach Food Request
Chapman is partnering with the PTA to provide food baskets for families in need. If you would like assistance, please fill out all the following information
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* Indicates required question
Feel free to reach out to our School Counselor, Wendi Williams,
wewilliams@pps.net
, (503) 916-6295 for any questions.
*Please return this form by November 15th, 2021
Caregiver First & Last name
*
Your answer
Current Students at Chapman:
#1 Student First Name, Last Name and Grade
*
Your answer
#2 Student First Name, Last Name and Grade
Your answer
#3 Student First Name, Last Name and Grade
Your answer
Current Address (include Apt #):
*
Your answer
Best Phone Number to Reach you:
*
Your answer
Our Family would like to request assistance with the following items:
Thanksgiving Food Basket (groceries for Thanksgiving meal)
*
Yes
No
Winter Break Food Basket (breakfast and lunch foods)
*
Yes
No
Number of adults in your family:
*
Choose
1
2
3
4
5
6
Number of children in your family:
*
Choose
1
2
3
4
5
6
We need...
gluten-free meals
nut-free meals
Special note:
Your answer
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