Request edit access
2019 Holiday Central Application
HOLIDAY CENTRAL DISTRIBUTION DAY WILL BE SATURDAY, DECEMBER 7, 2019.
YOU MUST BE AVAILABLE TO ATTEND TO RECEIVE BENEFITS.

Food and Cleaning/Hygiene Baskets will be prepared for each qualifying household.
Applicants with children will also be eligible to apply for clothing and toys/gifts for each child.

APPLICATION INSTRUCTIONS:

Applications will remain open October 1- October 31. Applications will not be accepted after that date.

Only one application per household.

All applicants must live within the Mount Vernon School District.

Each Child (birth - 12th grade) must live within the household.

School-aged children attending public schools must be eligible to receive free or reduced lunches.

**Completing an application does not automatically qualify you for assistance. If you are eligible for assistance, you will receive an invitation in the mail.**
Last Name of Head of Household *
Your answer
First Name of Head of Household *
Your answer
Age of HoH *
Gender of HoH *
Number of People Who Live in Household *
Names, Gender, & Ages of Other ADULTS Living in Household (>18 years) *
ex. Doe, John M 46; Doe, Jane F 48 (Put N/A if no other adults live within the household.)
Your answer
Street Address *
ex. 123 Holiday Central Lane
Your answer
City, State, Zip *
NOTE: If your town does not appear as a choice, you will not qualify for HC. Only these addresses are within the Mt. Vernon school district.
Phone Number *
ex. 417-123-4567
Your answer
Email
Your answer
Alternate Contact Person *
Name & number please
Your answer
Are you applying for Children's Toys and Clothing? *
If yes, you will be directed to furnish your children's information next. If no, we will prepare a food and cleaning/hygiene basket designed for your household.
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service