Bed Blitz Application
Please fill out all parts of this application so we may properly assess your child’s need for a bed.
APPLICATION MUST BE RECEIVED ELECTRONICALLY OR ON PAPER AT THE TOOL LIBRARY BY 7PM, SEP 26TH, 2019.
*Please note: some of the information gathered is for statistical purposes, please answer honestly.
Information provided is kept confidential.
Additional Information and Instructions
Please understand not all applicants will receive a bed.
Only school age children 4-18 who are currently in school are eligible to apply.
There is only one design for beds (you may not make special requests).
Two weeks after the application deadline determinations will be made. We will contact you through mail, e-mail or phone that you provided with a pick up date and location (do not contact us).
Please fill out all information honestly and to the best of your ability.
Please provide accurate contact information.
It is your responsibility to notify us if your contact information changes. Please do so via us postal service or e-mail
(failure to do so may result in a loss of awarded bed)
Incomplete applications will not be considered.
You must make arrangements to pick up your bed if you are receiving a bed (beds will not be delivered).
Multiple requests for one family does not guarantee all applicants will receive a bed.
Eligibility is determined by timely submission, complete information, and need.
Any questions or concerns, please email
or call the office at 309-829-1200. Thank you!
Name of Guardian/Parent (first & last name)
Relationship to Child
Best phone # to reach you (with area code)
COMPLETE Mailing Address: street/city/zip code
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This form was created inside of West Bloomington Revitalization Project.
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