School Supplies and Clothing Assistance Application

 

Application should be completed and returned to the above address.  Do not leave any spaces blank.  A telephone number must accompany this form.  Your child must attend a school in Hendricks County and be in Grade K – 8 to participate.  On the shopping day, your child will need to bring a copy of the school supply list with them.  (Use back of Form for Additional Children)

 

Child’s Name: _________________________________________  Age:  ___________ Grade:  ________

 

Child’s Name: _________________________________________  Age:  ___________ Grade:  ________

 

Child’s Name: _________________________________________  Age:  ___________ Grade:  ________

 

Name of Responsible Party: _______________________________________________________________

 

Relationship to Child: (Circle One)    Guardian      Parent

 

Address:  _____________________________________________ 

 

City:____________________________

 

Telephone Number:____________________  Best time to call: __________________

 

Total Annual Household Income: (Check One)

______  $0 to $10,000.00

______  $10,000.00 to $15,000.00

______  $15,000.00 to $20,000.00

______  $20,000.00 to $25,000.00

______  $25,000.00 to $30,000.00

______  Over $30,000.00

 

Number of persons in household:  ____________

 

Have you recently been laid off?  (Circle One)  Yes    No

 

Name of School: ______________________________________  First Day of School:  _______________

 

Form should be completed and mailed to:                     Megen Morgan – wingslion@aol.com

                                                                                                1408 Backwater Drive, Danville IN  46122