Barrow County Holiday Connection
2017 Application for Assistance
Guardian/Caretaker
Your answer
Relationship to Child
Your answer
Phone Number
Your answer
Email Address
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
What city do you live in?
Do you qualify for free or reduced lunch?
If no, please explain any special circumstance that requires you to seek Holiday Connection Assistance. Also, please provide the verifying agency.
Your answer
Were you referred to Holiday Connection through the United Way?
Have you ever used Holiday Connection before?
If so, how many years have you used Holiday Connection?
Years
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