Section 1 of 4
Beaverton Buddies Program. Family Promise of Greater Washington County.
Welcome to the Beaverton Buddies Supply Request Form!
This form is for families requesting supplies through our Beaverton Buddies Program. Each household may submit one request once every three months during the school year (September–June).
Please note the following:
This form is for families requesting supplies through our Beaverton Buddies Program. Each household may submit one request once every three months during the school year (September–June).
Please note the following:
- Some items are seasonal or limited in quantity. If we’re unable to fulfill part of your request, we’ll let you know.
- Supply pick-up is available every Friday at our Beaverton House Shelter.
- Once your order is ready, you will receive a text and email notification. You will have one week from the date of contact to pick up your order before items are restocked.
- If you need a different pick-up day or time, let us know in the form and we will do our best to accommodate.
- Delivery may be available on a limited, case-by-case basis. We ask that you explore your own transportation options before requesting delivery.
¡Bienvenidos al Formulario de Solicitud de Suministros de Beaverton Buddies!
Este formulario es para familias que desean solicitar suministros a través de nuestro programa Beaverton Buddies. Cada hogar puede enviar una solicitud una vez cada tres meses durante el año escolar (de septiembre a junio).
Tenga en cuenta lo siguiente:
Algunos artículos son estacionales o limitados en cantidad. Si no podemos cumplir con ciertas solicitudes, se lo haremos saber.
Este formulario es para familias que desean solicitar suministros a través de nuestro programa Beaverton Buddies. Cada hogar puede enviar una solicitud una vez cada tres meses durante el año escolar (de septiembre a junio).
Tenga en cuenta lo siguiente:
Algunos artículos son estacionales o limitados en cantidad. Si no podemos cumplir con ciertas solicitudes, se lo haremos saber.
- Algunos artículos son estacionales o tienen cantidad limitada. Si no podemos cumplir con parte de su solicitud, se lo haremos saber.
- La recolección de suministros se realiza todos los miércoles y viernes en nuestro refugio Beaverton House.
- Una vez que su pedido esté listo, recibirá una notificación por mensaje de texto y correo electrónico. Tendrá una semana desde la fecha de contacto para recoger su pedido antes de que los artículos sean devueltos al inventario.
- Si necesita un día u horario diferente para recoger su pedido, indíquelo en el formulario y haremos todo lo posible por acomodarlo.
- La entrega puede estar disponible en casos limitados y especiales. Le pedimos que intente buscar opciones de transporte propias antes de solicitar entrega.
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Section 2 of 4
Untitled Section
Parents first and Last name/ El nombre completo de la mama o papa.
Parents first and Last name/ El nombre completo de la mama o papa.
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What is your Phone Number/Cual es su numero de telefono?
What is your Phone Number/Cual es su numero de telefono?
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What is your email address/¿Cual es tu dirección de correo electrónico?
What is your email address/¿Cual es tu dirección de correo electrónico?
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Preferred Language/ Idioma preferido
Preferred Language/ Idioma preferido
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Preferred contact method/ Metodo preferido para contactarlo
Preferred contact method/ Metodo preferido para contactarlo
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Phone/ Telefono
Email/Correo Electronico
Both
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Please list the names and ages of each member in your household (for example: Jane 7, Jorge 40, etc.)
Please list the names and ages of each member in your household (for example: Jane 7, Jorge 40, etc.)
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You can pick-up at our Beaverton shelter. If this does not work for you, please list below with a preference of receiving these items. Puede recogerlos en nuestro refugio de Beaverton. Si no le resulta posible, indique a continuación su preferencia de recepción.
You can pick-up at our Beaverton shelter. If this does not work for you, please list below with a preference of receiving these items. Puede recogerlos en nuestro refugio de Beaverton. Si no le resulta posible, indique a continuación su preferencia de recepción.
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List full address (including apartment number and complex name if applicable) Listar dirección completa (Incluyendo el número de apartamento y el nombre del complejo, si corresponde)
List full address (including apartment number and complex name if applicable) Listar dirección completa (Incluyendo el número de apartamento y el nombre del complejo, si corresponde)
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Do you have at least one child who resides in your household and is enrolled in the Beaverton School District? If so, please list that child's/those children's names.
Do you have at least one child who resides in your household and is enrolled in the Beaverton School District? If so, please list that child's/those children's names.
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No
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What race does each member of the household identify as?
What race does each member of the household identify as?
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Black, African American, or African
Asian or Asian American
American Indian, Alaskan Native, or Indigenous
Native Hawaiian or Pacific Islander
Multiple Races or Multiracial
Person 1
Person 2
Person 3
Person 4
Person 5
Person 6
Rows
1.
Person 1
2.
Person 2
3.
Person 3
4.
Person 4
5.
Person 5
6.
Person 6
7.
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Black, African American, or African
Asian or Asian American
American Indian, Alaskan Native, or Indigenous
Native Hawaiian or Pacific Islander
Multiple Races or Multiracial
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Which option best describes your household structure?
Which option best describes your household structure?
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1.
Single-Parent Household
2.
Two-Parent Houshold
3.
Multigenerational Household
4.
Non-Parental Guardian Care
5.
Other
6.
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Is anyone in your household a U.S. Veteran?
Is anyone in your household a U.S. Veteran?
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Yes
No
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Is anyone in your household a survivor of Domestic Violence?
Is anyone in your household a survivor of Domestic Violence?
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No
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Are you at risk of being evicted or losing your housing this month or next?
Are you at risk of being evicted or losing your housing this month or next?
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Yes
Continue to next section
No
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Maybe
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Our family is currently homeless
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Section 3 of 4
Housing Circumstances
What are the main challenges that are contributing to your current experience of housing instability?
What are the main challenges that are contributing to your current experience of housing instability?
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Unemployment
Utility Costs
Childcare Costs
Lease Ending
Personal Debt
Health Challenges
Unsafe Situation
Other
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add "Other"
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Has your family previously experienced homelessness?
Has your family previously experienced homelessness?
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Section 4 of 4
Requests
Do you understand that not all items on this list will be provided upon request? We are able to supply the items based off of donations FPGWC has recieved.
¿Entiende que no todos los artículos de esta lista estarán disponibles cuando los solicite? Podemos proporcionar los artículos según las donaciones que FPGWC haya recibido.
Do you understand that not all items on this list will be provided upon request? We are able to supply the items based off of donations FPGWC has recieved.
¿Entiende que no todos los artículos de esta lista estarán disponibles cuando los solicite? Podemos proporcionar los artículos según las donaciones que FPGWC haya recibido.
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Items needed/ Cosas que necesitan?
Items needed/ Cosas que necesitan?
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Shampoo/Conditioner (Shampoo y Acondicionador)
Body wash-Bar Soap/ gel de baño-Jabón en barra
Deodorant / Desodorante
Toothbrush/Toothpaste (Cepillo de dientes)
Toothpaste (pasta de dientes)
Sanitary Pads/Tampons (Toallas Saniarias/ Tampones)
Cleaning Products/ Productos de limpieza
Laundry Soap/ Jabón de lavandería
Dish Soap/Dishwasher Soap (jabón para platos/Jabón para lavavajillas)
Toilet Paper/ Rollo de papel
Diapers (Panales) limited selection avaiable at this time.
Other:
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*If you are in need of any of the items below. Please include a few days and times you are able to come to our Promise Pantry*
*Si necesita alguno de los artículos a continuación, por favor, indique algunos días y horarios en que puede venir a nuestra Despensa Promise*
Items based on donations
Clothes, shoes, socks, jacket, Men's, Women's, Children's/Ropa, zapatos, calcetines, chaqueta, Hombres, Mujeres, Niños.
*If you are in need of any of the items below. Please include a few days and times you are able to come to our Promise Pantry*
*Si necesita alguno de los artículos a continuación, por favor, indique algunos días y horarios en que puede venir a nuestra Despensa Promise*
Items based on donations
Clothes, shoes, socks, jacket, Men's, Women's, Children's/Ropa, zapatos, calcetines, chaqueta, Hombres, Mujeres, Niños.
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Limited Selection Available (Diaper size etc.) / Selección limitada disponible (Talla de panales etc.)
Limited Selection Available (Diaper size etc.) / Selección limitada disponible (Talla de panales etc.)
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How did you hear about the Beaverton Buddies program? ¿Cómo se enteró del programa Beaverton Buddies?
How did you hear about the Beaverton Buddies program? ¿Cómo se enteró del programa Beaverton Buddies?
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