Bill Koloseike Relief Fund
Bill Koloseike Relief Fund will make Jewel-Osco gift cards available to Leo families who need help buying groceries or other household items or filling prescriptions.
Parent First Name
Parent Last Name
Student First Name
Student Last Name
Are you signed up for Auto-Pay?
Are you registered with FACTS?
What grade is your child in school?
Has your income been affected COVID-19 Vitus Shutdown? Please Explain
What is the best number to reach you?
What is your email address?
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Leo High School.