Family Intake Questionnaire
Stuck In The Middle's " Community ThanksGathering", and "Holiday Toy Drive".

ThanksGathering is a compassionate collaboration between SITM, its community, and its partners. They are combined in the spirit of gratitude and with the act of giving back. It takes place during the Thanksgiving season when many people come together to celebrate their blessings and share with those less fortunate.

A heartwarming initiative that aims to brighten the holiday season for children and families facing financial challenges. Our Holiday Toy Drive gathers toys and gifts to ensure that every child can experience the joy and magic of the holidays, regardless of their economic circumstances. It expresses generosity and community spirit, ensuring that children experience the joy, wonder, and excitement of the holiday season, regardless of their economic circumstances.

Family Eligibility Criteria:

    1.    Residency: Families w/children ages 0-17 must reside within Winslow Township, NJ.
    2.    Adversities: Families should be facing one or more of the following adversities:
  • The effects of a recent separation or divorce.
  • Coping with the loss of a parent or guardian.
  • Dealing with the incarceration of a parent or guardian.
    3.    Income Status: Families should demonstrate a need for assistance and may be living beyond the poverty line, with a focus on those in financial distress.

Stuck In The Middle exclusively organizes Thanksgathering and the Holiday Toy Drive. We will provide assistance in areas where possible. If we are unable to assist, we have compiled a list of resources from our partners or local organizations that we would like to share with you. We will gladly refer families to our partners or other local organizations for any other needs, such as financial assistance, food, clothing, or shelter.
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Email *
Parent's Full Name *
List each child's full name, grade, and school name. *
Address *
Cell Phone *
Are you separated, divorced, or have lost a partner due to a death or incarceration? *
Required
Family Size *
Ages of children *
Required
Do you rent or own? *

Describe your current living conditions and any housing challenges.

 *
How have you or your children been impacted by a separation, divorce, loss of parent, or the incarceration of a parent? *

Employment Status

 *
Required
Sources of Income *
Required
Outstanding Debt or Financial Challenges
Specific Needs

What are your most immediate needs or challenges? (e.g., food, housing, utilities, medical expenses):

 *

Are there any health issues, or mental or medical needs within your family? Please provide details.

 *
Children's Needs

Are there specific educational or childcare needs for your children? Describe any challenges related to your children's well-being.

 *
Support System

Do you have a support system in place, such as family members or friends who provide assistance? Please describe.

 *
Legal or Custodial Issues

In cases of divorce, separation, or incarceration, are there any legal or custodial issues you're currently dealing with?

 *

Please provide details (optional)

Community Resources

Are you aware of and have you utilized any community resources or assistance programs?

If so, please describe.

 *
Future Plans

What are your long-term goals and plans for improving your situation?

 *
Documentation and Verification

Are you able to provide any documentation to validate your need, such as income

statements, bills, or proof of receiving government assistance, official documents related to your situation?

 *
Cultural or Special Consideration

Are there any cultural or special considerations that we should be aware of to better assist your family? Please share any specific cultural or religious practices.

 *

We want to create programs that benefit families like yours. Please tell us a little about your child's interests, hobbies, what makes them happy or sad, etc. We want to hear about you too. So, please share what you're comfortable sharing. You are in a safe space here.

 *
We will provide assistance in areas where possible. If we are unable to assist, we have compiled a list of resources from our partners or local organizations that we would like to share with you. 
 *
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