Adoption Request Form

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PLEASE READ BEFORE SUBMITTING FORM

Stewartsville is now accepting applications for Holiday assistance for Stewartsville students. This is a needs-based program for students currently enrolled in the Stewartsville School District whose families are experiencing financial hardship.

We will be asking our donors to provide 1 item from each of 5 categories (want, need, wear, read, treat.) Please enter each child on their own separate forms.

If interested in applying, complete this form by WEDNESDAY, NOVEMBER 23rd. Applications will NOT be accepted after WEDNESDAY, NOVEMBER 23rd. You may also request a paper form through our school counselor (Ms. Bell.)

We are unable to provide for children in other school districts nor children not yet enrolled in school. We ask that you are not already receiving assistance through another Christmas gift program for students you apply for in order to assure as many families as possible receive help.

You will get a phone call if we find that you aren't eligible due to not being in the district or being on another organization's list.

If you do not receive a phone call, YOU ARE ELIGIBLE. It is the responsibility of the parent/guardian to pick up the gifts Monday December 19th. PLEASE CHECK YOUR EMAIL FOR DETAILS THE WEEK OF PICK-UP!

Email *

Child's Full Name *

Child's Gender and Age *

Parent First and Last Name and Phone Number *

Would you like the gifts to be

Wrapped

Unwrapped

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WANTS: (please include clothing sizes and indicate adult or child size). Please do not list expensive items as we have a budget for each child. Please list one or two wants: *

NEEDS: (if listing clothing, please include clothing sizes and indicate adult or child size). Please do not list expensive items as we have a budget for each child. Please list one or two needs (hygiene items, underwear, socks, hat, gloves, shoes):

WEAR: (please include clothing sizes and indicate adult or child size). Please do not list expensive items as we have a budget for each child. Please list one or two items to wear (sweats, jeans, socks, shirts, etc):

READ: Please list one or two items your student would read (author, book series, magazine, etc):

TREAT: Please list one or two treat items (favorite candy, snack, etc):

Send me a copy of my responses.

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